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，但无法提供其生物活性因子。这些因素可以增强免疫功能，促进新生儿的最佳生长发育。母乳也是早产儿(加拿大每年出生的35万名儿童中约10%)的最佳健康促进剂，他们经常生病，可能需要延长住院时间。然而，早产儿可能在住院期间与母亲分开，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捐献母亲的母乳分发给这些患病的新生儿。在OMB，捐赠的牛奶经过热巴氏杀菌(在62.5℃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，人类乳汁生物活性分子可能被灭活；2)蜡状芽孢杆菌，一种芽胞形成细菌，可以抵抗巴氏杀菌。由于目前的方法不能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，通过采用一种称为高压巴氏杀菌(HHPP)的非热巴氏杀菌方法，我们假设我们将能够保存牛奶的营养物质和生物活性分子。因此，OMB将能够分发能够充分发挥其多种有益的生物学/免疫学功能的捐赠者母乳，改善易受伤害婴儿的健康结果。 其次，我们将利用HHPP进一步减少蜡状芽孢杆菌的污染，并创建和部署基于基因组的生物信息学手段来区分非致病性和致病性蜡状芽孢杆菌。因此，我们的研究将有助于减少牛奶损失，并允许OMB为更多早产儿提供服务。

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.