Jacquie
I agree that this is a burning question, vital to
get right, and that it's likely to come up with
increasing frequency. There will be HIV+ mothers
who start formula-feeding and change their minds,
or - as you describe - small/sick babies whose
nutrition needs to be protected before the
mother's milk comes in sufficiently who need
supplements, and then their mothers will want to
continue breastfeeding..... and how long does the
formula-fed baby's gut take to heal after
exposure to formula, so that any HIV in the
breastmilk is not likely to pose a risk of
breastfeeding-associated transmission???
This question came up as a comment/question to a
Lactation Matters blog I wrote in February, (see
http://lactationmatters.org/2013/01/08/wabahivresource/
New HIV and Breastfeeding Resource from the World
Alliance for Breastfeeding Action (WABA) comment
from Susan and my reply dated 28 June
2013) You'll see that I answered that it might
be a good idea for the baby to receive
pasteurized EBM for 2-3 weeks before receiving
breastfeeding direct to give time for the gut to
heal and I was thinking of the Just One Bottle
information when I gave this figure.
As to the quantity of immunological components
which are retained in pasteurized or heat-treated
donor milk, Chantry and colleagues wrote in
2010 that flash-heating significantly decreased
total IgA and IgG concentrations. (Chantry CJ,
Israel-Ballard K, Moldoveanu Z, Peerson J,
Coutsoudis, Sibeko L and Abrams B. Effect of
Flash-heat Treatment on Immunoglobulins in
Breastmilk. J Acquir Immune Defic Syndr. 2009
July 1; 51(3): 264–267.
doi:10.1097/QAI.0b013e3181aa12f2. available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779733/pdf/nihms126967.pdf
) Similar decreases in anti-HIV-1 gp120 IgG,
anti-pneumococcal polysaccharide and
anti-poliovirus IgA occurred. Although the
latter was most affected, flash-heating retained
66% of the antigen binding ability. In contrast,
binding capacity of IgA and IgG to influenza
increased after flash-heating. It was concluded
that most breastmilk immunoglobulin activity
survives flash-heating, suggesting that
Flash-heated breastmilk is immunologically
superior to breastmilk
substitutes. Flash-heating achieves a higher
temperature (73 degrees C) for a shorter time
than Holder pasteurization (62.5 degrees C for 30
minutes), and I don't know if a similar affect
would be achieved with conventionally pasteurized vs flash-heated breastmilk...
If anyone has more exact and accurate info (with
references) then I would be very grateful to learn of it.
Best wishes to this mom and her little babies.
Pamela Morrison IBCLC
Rustington, England
-----------------------------------------
Date: Sat, 3 Aug 2013 08:53:21 +0200
From: Jacquie Nutt <[log in to unmask]>
Subject: Restoring gut flora on donor milk?
We have a small-twin in the high care unit receiving donor breast milk
(DBM), while the mother builds up a supply for him. However she had
previously opted to formula feed, and so the big-twin has had some formula.
The doctors have decided to give the healthy baby DBM too, in the hopes
that the mother will eventually be feeding both babies, and that in the
meantime his gut flora will normalise (if that is possible with pasteurised
milk.....the big question!)
I've re-read Marsha Walker's informative "Just One Bottle....."
http://www.naba-breastfeeding.org/images/Just%20One%20Bottle.pdf
The article says that it can take 2 - 4 weeks for this to happen *with
exclusive breastfeeding*. I'm wondering if there is any further research
on how this would work with exclusive donor milk feeding. Pasteurised
human milk is different in many ways to fresh milk... though obviously
better than formula.
The really complicating issue, the reason why we want to heal the gut in
this particular case, is that the baby is HIV exposed. (In South Africa,
HIV+ mothers chose to breastfeed exclusively OR formula feed exclusively.)
So it is vital to get this one right. Obviously donor milk will be
better for the healthy baby than formula while in the hospital, but perhaps
the doctors shouldn't pin their hopes on this baby getting back to
exclusive breastfeeding?
I think this situation will arise again and again, so for me it's a burning
question.
Jacquie Nutt IBCLC
Drops for Life milk bank
www.drops4life.wordpress.com
Wellington, South Africa
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