title: Human Milk Processing: A Systematic Review of Innovative Techniques to Ensure the Safety and Quality of Donor Milk.
abstract: Pasteurization, performed at 62.5°C for 30 minutes (holder pasteurization), is currently recommended in all international human milk banks guidelines, but it affects some human milk bioactive and nutritive components. The present systematic review is aimed at critically reviewing evidence on the suitability of human milk processing techniques other than holder pasteurization, both thermal and nonthermal, to ensure microbiological safety, and on the effects of these techniques on biologically active donor milk components. A systematic review of English and non-English articles using Medline, PubMed, Embase, SCOPUS, and CAB Abstracts, with no restriction in publication date was performed. Search terms included: human, breast, donor, or banked milk, breastmilk, breast fed, breastfed, breastfeed; HTST, Flash, High Pressure, UV, ultrasonic or nonthermal; process, pasteuris, pasteuriz. Only primary research articles published in peer-reviewed journals were included, providing or not a comparison with holder pasteurized human milk, provided that the pasteurization technique was clearly described, and not intended for domestic use. Additional studies were identified by searching bibliographies of relevant articles. Twenty-six studies were identified as being relevant. Two examined both High Pressure Processing and High-Temperature-Short-Time pasteurization; 10 only examined High Pressure Processing; 10 only examined High-Temperature-Short-Time; 2 articles examined ultraviolet irradiation; 2 articles examined (thermo-)ultrasonic processing. The results indicate that data about safety for microbiological control are still scarce for most of the novel technologies, and that consensus on processing conditions is necessary for nonthermal technologies, before any conclusions on the qualitative and nutritional advantages of these techniques can be drawn.
authors.affiliation: *Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, Turin University, Turin, Italy †Nutricia Research, Utrecht, The Netherlands ‡Institute of Sciences of Food Production, National Research Council (CNR), Grugliasco §Food & Nutrition Research Center, Council for Agricultural Research and Economics (CREA), Rome, Italy ||Faculty of Earth and Life Sciences-Free University (VU) of Amsterdam, Amsterdam ¶Emma Children's Hospital-Academic Medical Centre (AMC), Amsterdam, The Netherlands #Italian Association of Human Milk Banks (AIBLUD), Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Peila
authors.forename: Nikki E
authors.initials: NE
authors.lastname: Emmerik
authors.forename: Marzia
authors.initials: M
authors.lastname: Giribaldi
authors.forename: Bernd
authors.initials: B
authors.lastname: Stahl
authors.forename: Joost E
authors.initials: JE
authors.lastname: Ruitenberg
authors.forename: Ruurd M
authors.initials: RM
authors.lastname: van Elburg
authors.forename: Guido E
authors.initials: GE
authors.lastname: Moro
authors.forename: Enrico
authors.initials: E
authors.lastname: Bertino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Coscia
authors.forename: Laura
authors.initials: L
authors.lastname: Cavallarin
mesh_terms: D059022:Food Safety / Q000379:methods*; D006801:Humans; D017784:Milk Banks / Q000592:standards*; D008895:Milk, Human / Q000737:chemistry / Q000382:microbiology; D061352:Pasteurization / Q000379:methods* / Q000592:standards