Refining processes to maximize the provision of donor human milk rich in nutrients and bioactive components: An integrated multidisciplinary approach at a human milk bank serving critically-ill neona

婴儿配方奶粉试图模仿人类母乳的营养成分，但不能提供其生物活性因子。这些因素可以增强免疫功能，促进新生儿的生长发育。母乳也是早产儿（加拿大每年出生的35万名婴儿中约有10%）最好的健康促进剂，早产儿经常生病，可能需要长期住院治疗。然而，早产儿可能在住院期间与母亲分离，或者母亲可能由于自己的疾病和/或与早产有关的压力而无法产生足够的母乳供应。罗杰斯·希克森安大略省母乳银行（OMB）通过处方，将经批准的母乳捐赠给这些患病的新生儿。在OMB，捐赠的牛奶进行热巴氏消毒（在62.5°C下加热30分钟）。这种热处理有两个基本问题：1)营养成分受到影响，人乳的生物活性分子可能被灭活；2)蜡样芽孢杆菌，一种孢子形成细菌，可以抵抗巴氏灭菌。由于目前的方法无法区分致病性和非致病性蜡样芽孢杆菌，OMB必须丢弃15-30%的牛奶供应。我们已经组建了一个多学科团队，将同时解决这两个问题。首先，通过采用一种被称为高流体静压巴氏灭菌（HHPP）的非热巴氏灭菌方法，我们假设我们将能够保存牛奶中的营养成分和生物活性分子。因此，管理和预算办公室将能够分配能够充分发挥其多种有益生物/免疫功能的捐赠母乳，改善脆弱婴儿的健康结果。

Infant formulas attempt to mimic the nutrient composition of human breastmilk, but cannot provide its bioactive factors. These factors enhance immune function, and optimum growth and development of the newborn. Human milk is also the best health promoter for preterm babies (approximately 10 % of the 350,000 children born annually in Canada), who are often ill and may require extended hospitalization. However, preterm babies may be separated from their mothers while hospitalized, or mothers may not be able to produce an adequate milk supply due to their own illness and/or stress associated with preterm delivery. The Rogers Hixon Ontario Human Milk Bank (OMB) dispenses, by prescription, milk from approved donor mothers to these ill newborns. At the OMB, donated milk undergoes thermal pasteurization (heating at 62.5°C for 30 min). This heat treatment has two fundamental problems: 1) nutrient composition is affected and human milk bioactive molecules may be inactivated, and 2) Bacillus cereus, a spore-forming bacterium, can resist pasteurization. Because current methods cannot differentiate between pathogenic and non-pathogenic B. cereus, the OMB must discard 15-30% of their milk supply. We have formed a multidisciplinary team that will tackle these two problems simultaneously. Firstly, by adopting a non-thermal pasteurization method known as high hydrostatic pressure pasteurization (HHPP), we hypothesize that we will be able to preserve milk nutrients and biologically active molecules. Consequently, the OMB will be able to dispense donor milk that can fully exert its multiple beneficial biological/immunological functions, improving health outcomes for vulnerable infants. Secondly, we will leverage HHPP to further reduce B. cereus contamination, and create and deploy genome-based bioinformatics means to differentiate between non-pathogenic and pathogenic B. cereus. As a result, our research will help reduce milk losses, and permit the OMB to serve more preterm newborns.