PASTEURIZED BREASTMILK AS A REPLACEMENT FEED
FOR
THE BABIES OF HIV-INFECTED MOTHERS

CURRENT INTERNATIONAL HIV AND INFANT FEEDING GUIDELINES
suggest that when children born to women living with HIV can be ensured uninterrupted access to nutritionally adequate breast-milk substitutes that are safely prepared and fed to them, they are at less risk of illness and death if they are not breastfed. It is considered that milk in some form is essential, and replacement feeding options include commercial infant formula, and home prepared formula which can be made from animal milks, typically from cows, goats, buffaloes or sheep (UNAIDS 1998). However, the possibility that mothers could use their own treated breastmilk as a replacement for breastfeeding directly has received scant attention.

A study conducted in 1993 (Orloff et al) for the Human Milk Banking Association of North America established that HIV in breastmilk could be inactivated by Holder pasteurization (heating to 62.5 degrees C for 30 minutes). Dr Caroline Chantry and colleagues published a paper in 2000
describing a small study conducted in Puerto Rico to examine virus in the expressed breastmilk of a small number of HIV+ mothers. Although HIV could be identified in the milk of 88% of the women, it could not be recovered from any of the samples after flash-boiling (bringing breastmilk
just to boiling point, so that bubbles appear around the edge of the container).
(Chantry 2000). In 2000 and 2001, Dr Bridget Jeffery in Pretoria described and researched another method of home-pasteurization which could be employed using very simple implements available in the homes of ordinary women living in resource-poor settings. (Jeffery et al 2000, and 2001)
The Zimbabwe Ministry of Health officially presents the use of expressed breastmilk as a primary option to be considered by HIV+ mothers (Zimbabwe Ministry of Health 2000)
PASTEURIZATION OF BREASTMILK AT HOME, using simple equipment, is not only safe, but possible. Home-heated expressed breastmilk is the most logical feeding alternative for those women who wish to avoid any possibility of transmission of the virus to their babies by breastfeeding, yet wish to provide them with the most physiologically suitable milk for human infants.
The mother who provides her own milk for her baby has absolute control over her own milk supply and can assure her baby's food security for the whole time that she lactates. Heat-treated EBM is nutritionally superior to other replacement feeds, maintains some immunological protection, avoids the risk of allergy, and costs nothing. In addition, the hormonal impact on a mother who continues to lactate is likely to result in less stress, increased enjoyment of her baby and longer lactational amenorhhea, which contributes to a longer interval before the birth of the next child

PASTEURIZING BREASTMILK
Method 1. Flash-boiling.
Place milk in clean covered jar in a pan of water. Place pan on stove and
heat until bubbles appear around the edge of the milk. Cool milk and feed to baby.
Method 2. Pretoria pasteurization
Place 50ml - 150 ml expressed breastmilk in a clean covered glass jar. Boil
450 ml water in a small aluminium pot, and remove from heat-source. Place
milk jar upright in the pan of boiled water, cover the pan and leave for 15 - 20
minutes. Cool milk and feed to baby.
FEEDING EXPRESSED BREASTMILK
The baby will require the following quantities of breastmilk in order to
grow well and thrive (Adequate weight gain is considered to be a gain of
30g/day after the third day of life and up to 3 months, and 20g/day from 3
- 6 months):
Day 1 - approx 30 ml colostrum**
Day 2 - 60ml per kilogram per day
Day 3 - 90ml "
Day 4 - 120 ml "
Day 5-10 - 150 ml "
From Day 10 - 180ml/kg/day
** 28g = 1 oz
The baby can be fed the pasteurized, cooled breastmilk by cup, spoon or
bottle. Note, however, that bottle-feeding can be hazardous in
resource-poor environments since bottles and teats need to be thoroughly
sterilized before use.
email:pamela@ecoweb.co.zw