Credit: NASA/GSFC/Jeff Schmaltz/MODIS Land Rapid Response Team

Are you a mom who needs to pump and uses an electric pump?

• Consider getting a car adapter and/or a battery pack for your electric pump. Some electric pumps can also be converted to manual use – learn how to do this ahead of time.
• Consider getting a hand pump to use as your back-up pump.
• Learn how to hand express your milk.

Preventing your expressed milk from thawing

The first order of business is to try and prevent the milk from completely thawing. If there are still ice crystals in the milk, then it is still considered frozen–  it is safe to either use the milk  or return it to a working freezer.

Some ways to keep your milk frozen:

• If you have access to a generator, use it to operate your freezer during a power outage.
• If a neighbor or a nearby store has power, ask if you can store your milk in their freezer until power is restored. Make sure your milk has contact information on it!
• In your freezer (with no power): Open the freezer as little as possible. Food will stay frozen longer if the freezer is full: if you know ahead of time that you may lose power, fill empty spaces in your freezer with containers of water so that there is extra ice instead of empty space. Keep your expressed milk in the middle of the freezer, away from freezer walls. According to the USDA, “a full freezer will hold the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed.”
• In a cooler: Pack the cooler as full as possible, to slow thawing. Crumpled newspaper is a good insulator if there is extra air space in the cooler. Covering the cooler with blankets will also help to keep it cold.
• Extra air space in your freezer or cooler can be filled with dry ice, Techni Ice, “blue ice,” containers of water or ice, or snow.
• Are you in an area with snow on the ground? You may be able to store your milk in a snow bank, out of the sun, or use snow/ice to keep your milk cool in your freezer or cooler.

What if the milk has completely thawed?

Current guidelines recommend that this milk be used within 24-48 hours (24 hours if baby is a preemie or has immune issues that require stricter precautions) and not refrozen.

According to the Academy of Breastfeeding Medicine’s 2010 “Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants:”

There is little information on refreezing of thawed human milk. Bacterial growth and loss of antibacterial activity in thawed milk will vary depending on the technique of milk thawing, duration of the thaw, and the amount of bacteria in the milk at the time of expression. At this time no recommendations can be made on the refreezing of thawed human milk.

However, there is some information on refreezing human milk.  A 2006 study looked at the effects of refreezing previously frozen milk (Rechtman, Lee, & Berg, 2006). The researchers used donor milk that had been expressed by mothers without following any special sanitary guidelines. The frozen milk was thawed overnight at refrigerator temperature, separated into batches, then refrozen in separate batches and thawed for a second time to room temperature. At this point, different batches were (1) kept at 46°F/8°C for 8 or 24 hours; (2) kept at 73°F/23°C for 4 or 8 hours; (3) exposed to multiple freeze-thaw cycles of various lengths; and (control) kept at  -4°F/-20°C. Vitamin content was adequate for all the refrozen samples, and none of the sample batches that had been refrozen had unsafe levels of bacteria.

From the conclusion to this study:

The data generated by the authors support the contention that milk is relatively robust. Milk that has been left unrefrigerated for less than 8 hours, or placed in the refrigerator for a day, is safe to use and retains a good portion of its nutritional value. Moreover, it appears that unpasteurized milk that has been accidentally thawed remains safe to use provided it has not been left too long in an unthawed condition. Based on these data, it appears that unpasteurized milk that has thawed in the refrigerator for up to 8 hours may be safely refrozen. Moreover, this data would seem to support the use of frozen milk to which fresh milk has been added and then refrozen. This should allow for more convenient storage and for the salvage of milk that mothers might otherwise have been told to discard.

Rechtman DJ, Lee ML, Berg H. Effect of environmental conditions on unpasteurized donor human milk. Breastfeed Med. 2006 Spring;1(1):24-6. Also available here.  Commentary here: Study results about frozen breastmilk. Also discussed in Breastfeeding Answers Made Simple (Mohrbacher, 2010, p. 461-2).

Additional resources:

• Weathering a storm with a freezer stash of breastmilk by Katy Linda, IBCLC
• Power Failure and Frozen Expressed Breastmilk [PDF] from the Breastfeeding Coalition of Washington
• Mothers with Stored Human Milk and Pump Dependent Lactating Moms [PDF] from the Connecticut Breastfeeding Coalition
• Keeping Food Safe During an Emergency from the US Department of Agriculture
• Keep Food and Water Safe after a Natural Disaster or Power Outage from the US Centers for Disease Control
• 2011 Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes, and Child Care Settings. HMBANA. 3rd Edition 2011

 More:

• Infant Feeding in Emergencies
• Breastmilk Storage & Handling

by Diana Cassar-Uhl, IBCLC

Used with permission.

“Maybe you just need to try a little harder.”

“Have you tried fenugreek?”

“You’re probably not drinking enough water.”

Mothers who struggle with milk production hear advice like this from well-meaning friends and family members (and sometimes, from breastfeeding supporters who should know better).  While the vast majority of milk production problems can be remedied by addressing issues of breastfeeding management, there are some for whom making enough milk to sustain their babies is difficult or impossible.  Called primary lactation failure, this condition occurs when a mother’s body does not make an adequate amount of milk for her baby, even when everything else (including but not limited to: latch and positioning, breastfeeding frequency and exclusivity, mother and baby are kept together, baby’s oral anatomy is fine – no tongue tie, cleft palate) is in order. Primary lactation failure can be due to a variety of factors, including previous thoracic or breast surgery that severs critical nerves or ductwork; hormonal complications, such as those that accompany polycystic ovarian syndrome or thyroid abnormalities; and a condition in which mammary tissue simply did not develop during adolescence.  Called tubular (or tuberous) breast deformity in the plastic surgery literature, hypoplasia of the mammary gland (also called insufficient glandular tissue or IGT) was previously thought to be a simple issue of cosmetics – corrections addressed the appearance of a woman’s breasts, with little regard for their function.  However, as breastfeeding gains significance as an issue of public health, more mothers seek to nourish their babies in this manner, but little is known about what to do when breastfeeding doesn’t work.

Why don’t some mothers make milk?

Lactation failure can be classified into three categories: preglandular, glandular, and postglandular (Morton, 1994).  A preglandular cause for low or no milk production is directly related to hormonal issues such as a retained placenta or postpartum thyroiditis.  Postglandular causes of insufficient milk production are those things that happen after the baby is born that get breastfeeding off to a “bad start,” like a baby who cannot properly transfer milk at the breast (for whatever reason), or poor breastfeeding management, such as scheduled feeds, extended separation of mother and baby.  Glandular causes for low or no milk production can include previous breast surgery, or hypoplasia/IGT.  Often, glandular lactation failure is accompanied by one or more preglandular and postglandular factors.  Understanding your own body and health, asking questions about any medications or behaviors your doctor recommends during your pre-conception time, and being at a healthy body mass index (BMI) before becoming pregnant can help normalize your hormones.  Expert breastfeeding assistance from an IBCLC, as well as choosing a birth setting that is Baby-Friendly, can help you ensure that breastfeeding gets off to the best start possible.

Do I have hypoplasia/IGT?

Image credit: Lisa Bartee

Hypoplastic breasts may be small or large. It is breast shape, placement, and asymmetry that indicate hypoplasia — not necessarily size. Normal-sized breasts that are lacking glandular tissue may be made up of fatty tissue that will sufficiently fill a bra cup.

In a study of 34 mothers by Huggins, Petok, & Mireles (2000), a correlation between the following physical characteristics and lower milk output was found:

• widely spaced breasts (breasts are more than 1.5 inches apart)
• breast asymmetry (one breast is significantly larger than the other)
• presence of stretch marks on the breasts, in absence of breast growth, either during puberty or in pregnancy
• tubular breast shape (“empty sac” appearance)

Additional characteristics that may indicate hypoplasia are:

• disproportionately large or bulbous areolae
• absence of breast changes in pregnancy, postpartum, or both

While a large percentage of mothers with IGT felt like their breasts were “different” or “something was wrong” during adolescence, it is usually not until pregnancy, when “the booby fairy doesn’t arrive” and her breasts change little or not at all, or after she has given birth, when she does not produce enough milk for her baby, that a mother knows she has insufficient glandular tissue.  An exception to this might be if she sought or received breast augmentation surgery earlier in her life.  Perhaps her plastic surgeon referred to “tuberous breast deformity” or “constricted breast,” both terms used to describe hypoplasia/IGT in the plastic surgery field.

It is important to consider that some mothers with the physical markers noted above have no trouble bringing in a full, normal supply of milk after giving birth.  However, a prenatal breast assessment that reveals physical characteristics consistent with hypoplasia/IGT should prompt extra attention to getting breastfeeding off to the best start possible.  As well, it can be especially foreboding if a mother does not notice any changes in her breasts during her pregnancy.

Why did this happen to me?  Why can’t I make enough milk?

Image Credit: Lisa Bartee

It cannot be stressed enough that, if lactation failure of a glandular nature is suspected, preglandular and postglandular factors are accounted for and properly ruled out.  It can be frustrating for a mother who really does have hypoplasia/IGT to keep being asked “have you tried X or Y,” but each well-intentioned care provider who asks such questions seeks to rule out the causes for low milk production that are far more common (and for which there are often effective fixes).  As a clinician, I prefer to ask mothers “what measures have you tried, and what other possible causes for this have you explored?”  This approach shows respect for the mother’s journey while also encouraging a full review of all of the factors that could contribute to the problem of insufficient milk production.

There is evidence (Rudel, Fenton, Ackerman, Euling, & Makris, 2011) to support a theory that exposure to high levels of certain environmental contaminants, namely dioxin and other endocrine disruptors, while in utero (exposure to accumulated contaminants in your mother’s body before you’re born) can predispose a woman to have insufficient breast growth during adolescence and pregnancy, the two times in her life her breasts should be growing.   In some cases, a girl’s breasts may grow during puberty, but perhaps that growth is asymmetrical (uneven) or the breasts are large and appear normal, but only fatty tissue developed, not glandular tissue.  This could be the result of hormonal irregularities that occur with some endocrine conditions, such as PCOS or uncontrolled thyroid or insulin-related conditions (Marasco, Marmet, & Shell, 2000).  Some mothers with hypoplasia/IGT report luteal phase defect, which is a cyclical occurrence of lower-than-normal progesterone, even in the presence of ovulation.  It is characterized by post-ovulatory basal body temperatures that do not rise significantly and may also result in pre-menstrual spotting.  These cases of endocrine irregularities are especially important to address, because the hormone issues that interrupted the development of glandular tissue may also be preventing what milk-making tissue is there from doing its job.  Normalizing these hormonal irregularities can help to maximize the performance of the glandular tissue that is present; this is why certain medications and herbs may have the effect of boosting milk production.  However, what works for one mother might not work for another; this area needs more research.

What can I do now?  I really wanted to breastfeed my baby.

Image Cresit: Lisa Bartee

Some mothers, after taking measures to maximize their milk production, make peace with the situation quickly and find joy in bottle-feeding their babies with love and sensitivity.  But, for the mother who envisioned breastfeeding as a vital part of her mothering experience, or the mother who is concerned with the risks of not providing human milk to her baby, the realization that her body isn’t going to produce what her baby needs to thrive can be devastating.  Fortunately, there are ways to preserve aspects of the breastfeeding relationship.  Again, it is imperative that all other potential causes of breastfeeding difficulty are ruled out, because any measure a mother takes to maximize and augment her milk production will be less effective if there are other factors at play, such as poor breastfeeding management or an inability on the baby’s part to effectively transfer milk.  It is also vital to connect with other breastfeeding mothers and become familiar with the behavior of a normal breastfed baby; mothers who make plenty of milk worry that their babies aren’t getting enough when they’re fussy, if they feed often, or aren’t long sleepers.  These aspects of normal newborn behavior may be especially unsettling to a mother with IGT, but a good understanding of what “normal” looks and acts like can smooth the process of re-developing trust in her own instincts about what her baby needs.

Photo credit: Nyssa Retter

Some mothers with hypoplasia/IGT are able to offer all feedings at their breasts, regardless of how much milk their breasts actually make, using an at-breast supplementing tool.  This tool consists of a small tube that is taped beside or under the mother’s nipple; the tube is connected to a container that holds the supplement, which may be the mother’s own pumped milk, milk from a donor, or formula.  Other mothers find that they are able to breastfeed and provide most of what their babies need, perhaps with the support of galactagogue (milk-making) herbs or medications, and only need to offer supplements, either at the breast or via bottle, once or twice each day.  Your baby might be happiest if you offer an ounce by bottle, then latch him on to your breast once the edge has been taken off his hunger, and let him finish at your breast.  Some mothers with hypoplasia/IGT find that their babies need no additional donor milk or formula supplementation around the middle of the first year, when they’ve shown readiness for some solid foods.  One ounce of formula offers 20 calories; one ounce of mashed, ripe avocado provides 50 calories; banana and sweet potato each have 25 calories per ounce.  Depending on your baby’s weight gain and supplementation needs, nutrient-dense foods may provide adequate nourishment alongside the milk you are able to produce.  Your pediatrician can help you determine what is best for your baby.

The important thing is that you allow yourself the freedom to mourn the loss of the breastfeeding relationship you thought you would have.  In that process, identify what aspects of breastfeeding your baby you were most excited to experience, and seek out the help of an IBCLC with experience in supporting mothers with low milk production or IGT.  Help your IBCLC help you – do you want to learn how to pump and bottle-feed as much milk as you’re able to make?  Does the at-breast supplementer that just came in the mail confuse you, and you need some help getting going with it?  Maybe the idea of using milk donors appeals to you, but you want some more information before you move forward with that.  Talk to your IBCLC about the lengths you’re willing to go to, and your comfort level with your situation.   If she knows what your goals are, she can help you design a care plan that will suit your needs and your lifestyle.  With support, many mothers go on to achieve their goals and have successful, fulfilling breastfeeding experiences that are about much more than the ounces of milk they produce.

References

Huggins, K., Petok, E., & Mireles, O.  Markers of lactation insufficiency: a study of 34 mothers.  Current issues in clinical lactation 2000; 25-35. Retrieved from http://www.sonic.net/~mollyf/igt/

Marasco, L., Marmet, C., & Shell, E. (2000). Polycystic ovary syndrome: a connection to insufficient milk supply? Journal of Human Lactation, 16(2), 143-148.

Morton, J. A. (1994). The clinical usefulness of breast milk sodium in the assessment of lactogenesis. Pediatrics, 93, 802–806.

Neifert, M. R., Seacat, J. M., & Jobe, W. E. (1985). Lactation failure due to insufficient glandular development of the breast. Pediatrics, 76(5), 823-828.

Rudel, R. A., Fenton, S. E., Ackerman, J. M., Euling, S. Y., Makris, S. L. (2011). Environmental exposures and mammary gland development: State of the science, public health implications, and research recommendations. Environmental Health Perspectives 119(8): doi:10.1289/ehp.1002864

West, D., & Marasco, L. (2008). The Breastfeeding Mother’s Guide to Making More Milk. New York: McGraw-Hill.

Resources 

Image Credit: Lisa Bartee

Books:

West, D., & Marasco, L. (2008). The Breastfeeding Mother’s Guide to Making More Milk. New York: McGraw-Hill.  Website: http://lowmilksupply.org

Jacobson, H. (2004). Mother Food for Breastfeeding Mothers.

Humphrey, Sheila. (2003). The Nursing Mother’s Herbal.  Minneapolis: Fairview Press.

On Facebook:  IGT and Low Milk Supply Support Group

Online Community:  MOBI (Mothers Overcoming Breastfeeding Issues)

Blog:  Diary of a Lactation Failure

Website:  Not Everyone Can Breastfeed

Articles:

Supporting Mothers with Mammary Hypoplasia/Insufficient Glandular Tissue by Diana Cassar-Uhl, from Leaven, Vol. 45 No. 2-3, 2009, pp. 4-14.

A cup or two, for my best friend by Diana Cassar-Uhl

Podcasts:

When the “booby fairy” doesn’t arrive – insufficient glandular tissue/breast hypoplasia

Breast Hypoplasia and Breastfeeding

General Articles at KellyMom:

Milk supply articles

Tools for Feeding: Alternative Feeding Methods – Bottles & More

Help — My Baby Won’t Nurse!

About the author:

Diana Cassar-Uhl, IBCLC and La Leche League Leader, is a frequent contributor to Breastfeeding Today and is the author of La Leche League’s “Vitamin D, Your Baby, and You” information sheet. She is pursuing a Master of Public Health and hopes to graduate in May of 2013. Diana enjoys speaking at breastfeeding education events; her speaker profile can be viewed at http://lactspeak.com/speaker/dianacassar-uhl . She blogs about normalizing breastfeeding in American culture at http://DianaIBCLC.com, and is writing a book about breastfeeding with hypoplasia/IGT, to be released by Praeclarus Press in spring 2013. Mother to Anna, Simon, and Gabriella, Diana spent 17 years as a clarinet player on active Army duty with the West Point (NY) military band.

• Making milk when there is no baby to feed from the Motherwear blog
• Bryson’s Legacy: A Story of Milk Donation and the Love of a Family
• Lactation after Perinatal, Neonatal, or Infant Loss by Melissa Cole, IBCLC, RLC, from Clinical Lactation 2012, 3(3):94-110.
• Lactation After Loss: A Guide for Bereaved Mothers from Empty Arms Bereavement Support
• Weaning after infant loss from Children’s Hospitals and Clinics, Minneapolis and St. Paul, MN
• Lactation Suppression: Forgotten Aspect of Care for the Mother of a Dying Child by Debra Busta Moore and Anita Catlin, from Pediatric Nursing 2003, 29(5):383-384.

• Human milk banking and other donor milk
• Lactation suppression

NABA

by Marsha Walker, RN, IBCLC

Reprinted with permission from the USLCA February 2012 eNews

Keeping up with which companies are meeting their obligations under the International Code of Marketing of Breastmilk Substitutes (the Code) can be a daunting task. Who is compliant and who is not is constantly changing, especially as companies merge, enter marketing agreements, or acquire subsidiaries. Companies who are owned by Code violators are considered the same as their parent. The lineage of manufacturers and distributors of products covered by the Code must be kept in mind. So long as any company is found to be a Code violator, sponsorship is not accepted from its parent or subsidiary company even though the parent or subsidiary company may not be a Code violator.

In the case of a subsidiary company, the parent company is in control of the subsidiary’s policies and practices and there is advantage in keeping the subsidiary’s record relatively clean so that health workers can work with the subsidiary while the parent company continues to violate the Code. Strategically, it means one company benefits from endorsements by health workers because it is Code compliant while the other continues to reap the benefits of aggressive promotion. Since the decision makers of both companies are one and the same, the parent company must not be allowed to take advantage of the goodwill that the subsidiary may receive from health workers as a result of any sponsorship they offer. Using the corporate veil to shield one arm of a group of companies from possible wrongful deeds of another is unethical and would exonerate the parent company from its responsibilities under the Code. There is a compelling case to lift the corporate veil to protect infant health and health care providers are encouraged to do so. Companies must not be rewarded for poor corporate behavior.

Creating a list of companies who are Code violators and who are not Code violators is difficult at best, but below is a selected list of a few companies who are and are not Code violators that may be involved with infant feeding. Hopefully, this is helpful to readers. I am happy to answer any questions you may have.

Code violators:

(revised 9/2012)

• All infant formula companies
• Boppy
  (owned by the Artsana Group, maker of Chicco branded infant products which are marketed in a Code violating manner)
• Medela
  (markets the Calma feeding bottle and nipple in a Code violating manner)
• Ameda
  (Owned by Evenflo who sold their infant feeding product line to Kimberly Clark of Mexico but continues to market bottles under a transition agreement)
• Simplisse
  (co-marketing with Dr. Brown bottles and Handicraft who are both Code violators)
• Lansinoh
  (owned by Pigeon, a Code violator and markets the mOmma bottle in a Code violating manner)
• Prolacta
  (co-marketing their product with Abbott)
• Playtex
  (markets infant feeding bottles in a Code violating manner)
• The First Years
  (markets infant feeding bottles in a Code violating manner)
• Phillips Avent
  (markets infant feeding bottles in a Code violating manner)

Companies meeting their obligations under the Code:

• Hygeia
• Limerick
• Bailey Medical
• Motherlove
• My Brest Friend
• Snappies
• Cottonwood Kids

_____________________________________________

Want to find out more about the International Code of Marketing of Breastmilk Substitutes?

Infant formula, feeding bottles, and artificial nipples are the main products that fall within the scope of the Code. Pacifiers and breast pumps are not under the scope of the Code. Note that the Code only applies to the marketing of these items– it does not affect whether they are sold or used.

What is the WHO-CODE? (Best for Babes)

A Summary of the WHO Code (including WHERE, WHAT, WHEN and HOW) (Snugabell)

Health Implications of Direct Advertising of Infant Formula (World Health Organization)

Summary of the International Code on Marketing of Breast Milk Substitutes (Massachusetts Breastfeeding Coalition)

Summary of WHA Resolutions Relevant to the Code (INFACT Canada)

International Baby Food Action Network: The International Code (IBFAN)

How to report unethical promotion of formula, bottles and other breastmilk substitutes (PhD in Parenting)

Looking for WHO Code compliant companies? Some of them are part of Best for Babe’s CARE-WHO Alliance. Their list of companies is here: CARE-WHO Corporate Alliance.

Image courtesy of the Mothers' Milk Bank in Denver

Many mothers wonder why the non-profit HMBANA human milk banks pasteurize their milk. Laraine Lockhart Borman, IBCLC, with the Mothers’ Milk Bank in Denver, explains…

The HMBANA Advisory Council, a panel of experts in areas of infectious disease, microbiology, neonatology, law, and other areas, determined  that because human milk has the potential to be an agent of infectious disease, pasteurization would be required of all member banks due to the extremely fragile health of the babies receiving this milk. The number one priority is the health and safety of the tiny preterm infants served.

With any type of storage or treatment of human milk, there is some loss of its original components. Mother’s milk that has been frozen and stored experiences a loss of vitamin A from exposure to light and vitamin C from exposure to freezing temperatures. Pasteurization is a very gentle, controlled heating process using special equipment that kills viruses and bacteria while still maintaining 95% of everything that was originally in the milk. While a few of the immune properties are lost, there are many more that survive the pasteurization process. In addition, some beneficial enzymes are actually activated by the pasteurization process. *

Bottom line is that mom’s own milk is best. When this is not available, pasteurized human milk, obtained from a certified milk bank, can be a lifesaving safe and healthy alternative that everyone can feel good about.

by Laraine Lockhart Borman, IBCLC, Mothers’ Milk Bank, Rocky Mountain Children’s Health Foundation, Denver, CO

Image courtesy of the Mothers' Milk Bank in Denver

From “Donor Human Milk for Preterm Infants” (Wight 2001):

The benefits and concerns regarding the use of human milk for preterm infants has been recently reviewed, with more factors, actions, and interactions being discovered frequently… Protective effects of human milk on infection rates have been observed with the use of both fresh and pasteurized milk… 
[note: see Heiman & Schanler 2006 for a recent review]

Pasteurization (56 or 62.5°C for 30 minutes) does affect some of the nutritional, immunologic and other components of human milk. Heat treatment at 56°C (133°F) or greater for 30 minutes reliably eliminates all functional white blood cells and bacteria, inactivates human immunodeficiency virus (HIV) and human T-lymphotropic virus, and decreases the titers of other viruses, but in one study did not eliminate cytomegalovirus (CMV). Holder pasteurization [62.5°C (144°F) for 30 minutes] reliably inactivates HIV and CMV, and will eliminate or significantly decrease the titers of most other viruses.

Immunologic factors are variously affected by heat treatment. With Holder pasteurization most of the secretory IgA, bifid growth factor, and lysozyme remain (0% to 30% destroyed), lipids are unaffected, but 57% of the lactoferrin, and 34% of the IgG are destroyed. The reader is referred to a more detailed recent review (Lawrence 1999).

In general, the nutritional components are altered somewhat, resulting in slightly slower growth when compared to infants fed unpasteurized raw human milk. Holder pasteurization does not appear to influence nitrogen absorption or retention in LBW infants. Most enzymes, growth factors, vitamins, and minerals are unchanged or minimally decreased. Heat treatment of donor milk appears to foster more rapid growth of intestinal epithelial cells by inactivating heat-labile inhibitory cytokines, allowing heat-stable epidermal growth factor to act. Freezing inactivates milk cells and most viruses, but does not appear to effect the nutritional or anti-infective quality of the milk. Microwaving clearly decreases the anti-infective properties of human milk; the higher the temperature, the greater the effect.

* Research: The effect of pasteurization on the anti-infective agents of human milk

Percent activity remaining after pasteurization at 62.5°C for 30 minutes (unless otherwise noted)

See also:  Effect of heat treatment or storage on antimicrobial factors in human milk

References

Bullen JJ, Rogers HJ, Leigh L. Iron-binding proteins in milk and resistance to escherichia coli infection in infants. Brit. Med. J. 1972; i:69-75.

Evans TJ, Ryley HC, Neale LM, Dodge JA, Lewarne VM. Effect of storage and heat on antimicrobial proteins in human milk. Arch. Dis. Child. 1978; 53:239-241.

Eyres R, Elliot RB, Howie RN, Farmer K. Low temperature pasteurization of human milk. N. Z. Med. J. 1978; 87:134-135.

Ford JE, Law BA, Marshall VME, Reiter B. Influence of the heat treatment of human milk on some of its protective constituents. Pediatr. 1977; 90:29-35.

Friend BA, Shahani KM, Long CA, Agel EN. Evaluation of freeze-drying, pasteurization, high-temperature heating and storage on selected enzymes, B-vitamins and lipids of mature human milk. J. Food. Prot. 1983; 46:330-334.

Gibbs JH, Fisher C, Bhattacharya S, Goddard P, Baum JD. Drip breast milk: its composition, collection and pasteurization. Early Hum. Dev. 1977; 1:227-245.

Gillin FD, Reiner DS, Wang, C-S. Human milk kills parasitic intestinal protozoa. Science. 1983; 221:1290-1292.

Goldblum RM, Dill CW, Albrecht TB, Alford ES, Garza C, Goldman AS. Rapid high-temperature treatment of human milk. J. Pediatr. 1984; 104:380-385.

Goldsmith SJ, Dickson JS, Barnhart HM, Toledo RT, Eitenmiller RR. IgA, IgG, IgM and lactoferrin contents of human milk during early lactation and the effect of processing and storage. J. Food Prot. 1983; 46:4-7.

Heiman H, Schanler RJ. Benefits of maternal and donor human milk for premature infants. Early Hum Dev. 2006 Dec;82(12):781-7. Epub 2006 Oct 20.

Laegreid A, Kolsto Otnaess A-B, Orstavik I, Carlsen KH. Neutralizing activity in human milk fractions against respiratory syncytial virus. Acta Paediatr. Scand. 1986; 75:696-701.

Lawrence RA. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr Suppl. 1999 Aug;88(430):14-8. (Review)

Liebhaber M, Lewiston NJ, Asquith MT, Olds-Arroyo L, Sunshine P.  Alterations of lymphocytes and of antibody content of human milk after processing. Pediatr. 1977; 91:897-900.

Morgan JN, Toledo RT, Eitenmiller RR, Barnhart NM, Maddox F. Thermal destruction of immunoglobulin A, lactoferrin, thiamin and folic acid in human milk. J. Food Sci. 1986; 51:348-351.

Raptopoulou-Gigi M, Marwick K, McClelland DBL. Antimicrobial proteins in sterilized human milk. Br. Med. J. 1977; 1:12-14.

Stephens S, Dolby JM, Montreuil J, Spik G. Differences in inhibition of the growth of commensal and enteropathogenic strains of escherichia coli by lactotransferrin and secretory immunoglobulin A isolated from human milk. Immunology. 1980; 41:597-603.

Wardell JM, Wright AJ, Bardsley WG, D’Souza SW. Bile salt-stimulated lipase and esterase activity in human milk after collection, storage and heating: Nutritional implications. Pediatr. Res. 1984;18:382-386.

Welsh JK, May JT. Anti-infective properties of breast milk. J Pediatr. 1979 Jan;94(1):1-9.

Wight NE. Donor human milk for preterm infants. J Perinatol. 2001 Jun;21(4):249-54.

Wills ME, Han VEM, Harris DA, Baum JD. Short-time low-temperature pasteurization of human milk. Early Hum. Dev. 1982; 7:71-80.