Am J Perinatol 2012; 29(04): 283-288
DOI: 10.1055/s-0031-1295659
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Freeze–Thaw Process and Long Intervals after Fortification Denature Human Milk Fat Globules

Kenichiro Takahashi
1   Department of Pediatrics, Showa University of Medicine, Tokyo, Japan
,
Katsumi Mizuno
1   Department of Pediatrics, Showa University of Medicine, Tokyo, Japan
,
Kazuo Itabashi
1   Department of Pediatrics, Showa University of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

26 May 2011

26 August 2011

Publication Date:
21 November 2011 (online)

Abstract

Although mother’s milk is the optimal nutrition for preterm infants, the amount of protein, calcium, and phosphorus become inadequate for the growth of preterm infants, such that fortification is recommended when enteral feeding is established. Recently, intestinal obstruction due to calcium soap formation has been reported. All the reported cases were fed fortified thawed human milk. It has not been elucidated how human milk fortifier reacts with milk fat globules (MFGs) in thawed human milk. Therefore, we investigated whether freezing durations and time between fortification and enteral feeding denatured MFGs. Six samples of preterm mothers’ milk of each type (fresh unfrozen, 1-month frozen, and 12-month frozen) were analyzed. Fortifier was not added to the control. The samples were measured at 1, 12, and 24 hours after fortification. The MFG size distribution of each milk sample was measured. The freezing process enlarged the mode diameter (4.0 ± 0.4, 4.3 ± 0.7, and 4.5 ± 0.9 in fresh unfrozen milk, 1-month frozen, and 12-month frozen milk, respectively, p < 0.001). Fortification itself did not significantly alter the MFG size in thawed mother’s milk. However, a time lag of 12 hours after fortification enlarged the MFG size and resulted in smaller surface area per unit (3.6 ± 0.2, 3.3 ± 0.1, and 3.3 ± 0.1 m2/g, fresh unfrozen, 1-month frozen, and 12-month frozen, respectively) compared with 0 hours of time lag (3.8 ± 0.2, 3.5 ± 0.1, and 3.4 ± 0.2 m2/g, fresh unfrozen, 1-month frozen, and 12-month frozen, respectively). Not only the freeze–thaw procedure but also time lag after fortification affected MFG size. We recommend using fortified thawed human milk within 12 hours.

 
  • References

  • 1 Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103 (6 Pt 1) 1150-1157
  • 2 Hylander MA, Strobino DM, Pezzullo JC, Dhanireddy R. Association of human milk feedings with a reduction in retinopathy of prematurity among very low birthweight infants. J Perinatol 2001; 21: 356-362
  • 3 Okamoto T, Shirai M, Kokubo M , et al. Human milk reduces the risk of retinal detachment in extremely low-birthweight infants. Pediatr Int 2007; 49: 894-897
  • 4 Lucas A, Fewtrell MS, Morley R , et al. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. Am J Clin Nutr 1996; 64: 142-151
  • 5 Vohr BR, Poindexter BB, Dusick AM , et al; NICHD Neonatal Research Network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006; 118: e115-e123
  • 6 Wagener S, Cartwright D, Bourke C. Milk curd obstruction in premature infants receiving fortified expressed breast milk. J Paediatr Child Health 2009; 45: 228-230
  • 7 Karkiner A, Temir G, Hoşgör M, Günşar C, Karaca I. Ceacal perforation in a premature newborn infant complicating milk curd syndrome: case report. Turk J Gastroenterol 2003; 14: 148-150
  • 8 Koletzko B, Tangermann R, von Kries R , et al. Intestinal milk-bolus obstruction in formula-fed premature infants given high doses of calcium. J Pediatr Gastroenterol Nutr 1988; 7: 548-553
  • 9 Lewis CT, Dickson JA, Swain VA. Milk bolus obstruction in the neonate. Arch Dis Child 1977; 52: 68-71
  • 10 Jensen RJ. Fat-soluble vitamins in bovine milk. In: Jensen RG, ed. Handbook of Milk Composition. San Diego: Academic Press; 1995: 718-726
  • 11 Jensen RG. Determinants of milk volume and composition. In: Jensen RG, ed. Handbook of Milk Composition. San Diego: Academic Press; 1995: 237-271
  • 12 Berkow SE, Freed LM, Hamosh M , et al. Lipases and lipids in human milk: effect of freeze-thawing and storage. Pediatr Res 1984; 18: 1257-1262
  • 13 Garza C, Hopkinson J, Schanler RJ. Human milk banking. In: Human Milk in Infant Nutrition and Health. Springfield, IL: Charles C. Thomas; 1986
  • 14 Mizuno K, Nishida Y, Taki M , et al. Is increased fat content of hindmilk due to the size or the number of milk fat globules?. Int Breastfeed J 2009; 4: 7
  • 15 Michalski MC, Briard V, Michel F, Tasson F, Poulain P. Size distribution of fat globules in human colostrum, breast milk, and infant formula. J Dairy Sci 2005; 88: 1927-1940
  • 16 Carnielli VP, Luijendijk IH, van Goudoever JB , et al. Feeding premature newborn infants palmitic acid in amounts and stereoisomeric position similar to that of human milk: effects on fat and mineral balance. Am J Clin Nutr 1995; 61: 1037-1042
  • 17 Michalski MC, Gassi JY, Famelart MH , et al. The size of native MFGs affects physico-chemical and sensory properties of Camembert cheese. Lait 2003; 83: 131-143
  • 18 Liu HX, Adachi I, Horikoshi I, Ueno M. Mechanism of promotion of lymphatic grig absorption by milk fat globule membrane. Int J Pharmaceut 1995; 118: 55-64