Breast-feeding
The process of feeding human milk to an infant, directly from the breast of a woman, usually the biological mother of the child. The milk is delivered directly from the mother’s mammary anatomy to the infant’s alimentary canal |
HIV HTLV-1 HCMV Some other maternal viruses (see ‘Risk involved in breast-feeding and cross feeding’) Persistent (fat soluble) environmental pollutants Orally bioavailable drug residues with small atomic weights
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Maternal viral load Maternal environmental pollutant load Maternal excretion of environmental pollutants Protective and bioactive substances including antimicrobials such as Ig, lactoferrin, lysozyme, peptides and carbohydrates Entero-mammary pathways
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Duration of breast-feeding (in some cases – see HTLV section) Absence of antibody in the breast milk Non-exclusive breast-feeding (i.e., when other solids or liquids are introduced before 6 months)
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PDHM and expressed breast milk
PDHM is expressed human milk that is refrigerated; transported; possibly frozen and defrosted; pooled (mixed together); pasteurised (Holder pasteurised – 62·5°C for 30 min); frozen; possibly transported; defrosted and warmed in preparation for feeding. The milk is either delivered to the infant’s alimentary canal from a container fitted with a rubber or silicone teat, or delivered through a tube if the infant is <32 weeks
Expressed breast milk is the same as above but not usually pasteurised and is not handled by the milk bank |
HIV HTLV-1 HCMV Persistent (fat soluble) environmental pollutants Orally bioavailable drug residues Bacterial contamination Chemical or other contamination Foreign proteins (e.g., when mixed with other milks such as cow milk)
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Donor under-screening Donor environmental pollutant load Degradation of protective and bioactive factors through pasteurisation including antimicrobials, for example, Ig, lactoferrin, lysozyme and peptides Pooling effect (i.e., colostrum, transitional and mature milk are pooled) Storage chain integrity (temperature; duration; sanitation) Quality assurance testing Adulteration of donor milk with non-human milk
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Decrease in beneficial microbial colonies Decrease in active and passive immune properties Absence of entero-mammary pathways
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PIF
A modified animal (usually bovine or goat) milk-based partial or total replacement for human milk. The constituents of these products vary, even while their nutritional profiles are strictly prescribed. These are powdered milk products that must be reconstituted and are usually delivered to the infant’s alimentary canal from a container fitted with a rubber or silicone teat |
Bacterial contamination Survival of bacterial spores in powdered products Chemical contamination Sustained nutritional excess/deficiency (through over – or under-dilution) Non-human-sourced components Contaminated water Residues from agrochemical and veterinary exposure (hormones, antibiotics, pesticides, etc.) Milk sources from non-human species Compositional degradation from processing Overheated water for reconstitution
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Manufacturing process Faulty batch testing Packaging material Storage chain integrity Hygiene standards of preparer and reconstitution process Storage duration before and after reconstitution Water temperature during reconstitution (e.g., loss of nutrients) Adulterations
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Mucosal injury Pathological gut pH Atopic sensitisation Inflammation Nutritional bioavailability Sustained nutrition inadequacy (through over dilution of PIF) Failure to seed/sustain beneficial microbial colonisation Absence of maternal immune system influence (passive immune components and active response through entero-mammary pathway) Scalding of mouth and digestive tract from overheated water during reconstitution PIF (increased infection risk)
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