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Journal of Tropical Pediatrics Advance Access published online on September 27, 2006
Journal of Tropical Pediatrics, doi:10.1093/tropej/fml043
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© The Author [2006]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Original Papers

Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage

K. Israel-Ballard 1 *, A. Coutsoudis 2, C. J. Chantry 3, A. W. Sturm 4, F. Karim 4, L. Sibeko 5, and B. Abrams 1

1 Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720-7360,USA
2 Department of Paediatrics & Child Health, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
3 Department of California, University of California, Davis Medical Center, CA 95817, USA
4 Department of Medical Microbiology, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
5 School of Dietetics and Human Nutrition, McGill University, Montreal, Canada

* To whom correspondence should be addressed.
K. Israel-Ballard, E-mail: ballardk{at}berkeley.edu


  Abstract

Heat-treated breastmilk is one infant-feeding option recommended by the WHO to reduce mother-to-child transmission of HIV in developing countries. Flash-heat, a simple pasteurization method that a mother could perform in her home, has been shown to inactivate cell-free HIV-1. Since heating may affect the naturally occurring antimicrobial properties found in breastmilk, storing heated breastmilk may present a safety issue in resource-poor settings due to lack of refrigeration and potential contamination. To address this, we investigated the ability of flash-heat to eliminate bacteria and to prevent growth over time compared with unheated breastmilk. We collected breastmilk samples from 38 HIV positive mothers in South Africa and aliquoted them to flash-heated and unheated controls. Samples were stored at room temperature for 0, 2, 6 and 8 h and then plated and incubated for 24 h at 37°C in CO2. We performed total colony counts and identified Escherichia coli, Staphylocuccus aureus and Group A and Group B streptococci. Unheated samples had a significantly higher number of samples positive for bacterial growth at each time point (p < 0.0001), as well as mean colony-forming units (CFU)/ml in those samples that were positive at each time point (p < 0.0001). In addition, unheated samples had a significantly higher rate of bacterial propagation over time than flash-heated samples when comparing log values of CFU/ml across 0-8 h (p < 0.005). No pathogenic growth was observed in the flash-heated samples, while the unheated samples showed growth of E. coli (n = 1) and S. aureus (n = 6). Our data suggest that storage of flash-heated breastmilk is safe at room temperature for up to 8 h.


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