Feasibility of Using Flash-Heated Breastmilk as an Infant Feeding Option for HIV-Exposed, Uninfected Infants after 6 Months of Age in Urban Tanzania

作者：Chantry Caroline J^*; Young Sera L; Rennie Waverly; Ngonyani Monica; Mashio Clara; Israel Ballard Kiersten; Peerson Janet; Nyambo Margaret; Matee Mecky; Ash Deborah; Dewey Kathryn; Koniz Booher Peggy

来源：JAIDS: Journal of Acquired Immune Deficiency Syndromes , 2012, 60(1): 43-50.

DOI：10.1097/QAI.0b013e31824fc06e

• HIV
• infant feeding
• breastmilk
• pasteurization
• feasibility
• heat-treatment
• Flash-heat
• maternal-to-child transmission

Objective: Heat-treating expressed breastmilk is recommended as an interim feeding strategy for HIV-exposed infants in resource-poor countries, but data on its feasibility are minimal. Flash-heating (FH) is a simple in-home technique for heating breastmilk that inactivates HIV although preserving its nutritional and anti-infective properties. Our primary objective was to determine, among HIV-infected mothers, the feasibility and protocol adherence of FH expressed breastmilk after 6 months of exclusive breastfeeding.
Design: Prospective longitudinal.
Participants: One hundred one HIV-infected breastfeeding mothers.
Setting: Dar es Salaam, Tanzania.
Intervention: Peer counselors provided in-home counseling and support on infant feeding from 2 to 9 months postpartum. Mothers were encouraged to exclusively breastfeed for 6 months followed by FH expressed breastmilk if her infant was HIV negative. Clinic-based staff measured infant growth and morbidity monthly, and mothers kept daily logs of infant morbidity. FH behavior was tracked until 9 months postpartum using daily logs, in-home observations, and clinic-based and home-based surveys. Bacterial cultures of unheated and heated milk samples were performed.
Results: Thirty-seven of 72 eligible mothers (51.4%) chose to flash-heat. Median (range) frequency of milk expression was 3 (1-6) times daily and duration of method use on-study was 9.7 (0.1-15.6) weeks. Mean (SD) daily milk volume was 322 (201) mL (range 25-1120). No heated and 32 (30.5%) unheated samples contained bacterial pathogens.
Conclusions: FH is a simple technology that many HIV-positive women can successfully use after exclusive breastfeeding to continue to provide the benefits of breastmilk while avoiding maternal-to-child transmission associated with nonexclusive breastfeeding. Based on these feasibility data, a clinical trial of the effects of FH breastmilk on infant health outcomes is warranted.

• 出版日期2012-5-1