Human Milk Processing: A Systematic Review of Innovative Techniques to the Ensure Safety and Quality of Donor Milk.

Objectives: Pasteurization, performed at 62.5[degrees]C for 30 min (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 non-thermal, to ensure microbiological safety, and on the effects of these techniques on biologically active donor milk components. Methods: Systematic review of English and non-English articles using Medline, Pubmed, Embase, SCOPUS and CAB Abstracts, with no restriction in publication date. Search terms included: human, breast, donor, or banked milk, breastmilk, breast fed, breastfed, breastfeed*; HTST, Flash, High Pressure, UV, ultrasonic or non-thermal; 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. Results: Twenty-six studies were identified as being relevant. Two examined both High Pressure Processing (HPP) and High Temperature Short Time (HTST) pasteurization; 10 only examined HPP; 10 only examined HTST; 2 articles examined UV irradiation; 2 articles examined (thermo-)ultrasonic processing. Conclusions: 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 non-thermal technologies, before any conclusions on the qualitative and nutritional advantages of these techniques can be drawn. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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