Abstract
Hunan milk has many benefits, such as optimal nutrition, easy digestibility and immunologic protection for infants and contains some growth factors that can protect immature tissue, promote maturation particularly of the gastrointestinal tract and promote healing of damaged tissue. The first human milk bank was set up in China last year and had 36 recipients including preterm infants and other sick children. But the authors found some almost unbelievable effects of human donor milk in a severely malnourished child following intestinal surgery. This case demonstrates that human donor milk is not only a food but also an important therapy to some children with malnutrition.
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Keywords
human milk, human milk bank, post-operative malnutrition
Background
Human milk has many benefits, such as optimal nutrition, easy digestibility and immunologic protection for infants and contains some growth factors that can protect immature tissue, promote maturation particularly of the gastrointestinal tract and promote healing of damaged tissue [1-3]. Donor human milk (DHM) is the preferred feeding when the mother’s own milk is not sufficient or not available. The first human milk bank was set up over 100 years ago . In premature infants DHM has been proven to be very effective for the prevention of infections and necrotizing enterocolitis (NEC), for reducing feeding intolerance and for improving long-term outcomes [4-6]. So, human milk banks are blossoming in North America and Europe since the mid of 1980’s. Since the first human milk bank was set up last year in China, DHM was used not only for preterm infants but also for children with other illnesses such as immune deficiency, malnutrition after intestinal surgery, cow milk allergy and serious infection. We have observed some amazing effects in sick children. The objective of this report is to present the case of a severely malnourished child following intestinal surgery.
Case Report
Xiao Jiang(an alias) was the first recipient of DHM from our milk bank. He was a 10-month old boy coming from Zhanjiang, a prefecture-level city in Guangdong province, China. He was admitted to the local hospital because of abdominal distention. After laparotomy his condition deteriorated more and more with high fever, bleeding under the skin, and weight loss from 9 kg to 5.5 kg. He developed a terrible intestine fistula and spontaneous rupture of the surgical incision. It seemed that there was no hope for survival and he was discharged from the hospital to home. Five days later, his parents took the boy to our hospital. On the 2nd day after admission, by the surgeon in charge obtained a nutrition consultation because of the patient’s severe malnutrition. Unfortunately, there appeared to be intestinal bleeding as the ileostomy output became brown after consumption of a bottle of formula( Fig 1 and Fig 2). So, he had to be given total parenteral nutrition until the intestinal active bleeding stopped on the 4th day in hospital. Then, we started the minimal enteral feeding with 10 ml DHM from our milk bank.
Methods
We gave him the DHM in a dose of only 10 ml after the intestinal bleeding stopped on the 5th day of admission and then gradually increased the amount by 20-30ml q3h daily until 130 ml q3h was reached (Table 1). Everyday we monitored whether he had vomiting, diarrhea, abdominal distension, and temperature, examined the abdominal wound and monitored ileostomy output and his general condition. At the same time, the patient’s weight was determined every day at first and every 5 day later.
Table 1 Feeding strategy and weight change of Xiaojiang
Date/days in hospital
PN
kcal/kg
Donor milk use
Weight
kg
day
dosage
ml
frequency
ml/d
ml /kg/d
2013-3-25/1st
55
0
0
0
0
0
5.50
2013-3-29/5th
55
1st
10
q3h
80
14.5
5.50
2013-3-30/6th
45
2nd
30
q3h
240
42.8
5.62
2013-4-1/7 th
40
3rd
50
q3h
400
68.9
5.83
2013-4-2/8th
25
4th
80
q3h
640
105.0
6.15
2013-4-3/9th
15
5th
100
q3h
800
1290.
6.25
2013-4-4/10th
0
6th
130
q3h
1040
162.5
6.46
2013-4-10/16th
0
12th
130
q3h
1040
153.0
6.84
2013-4-15/21th
0
17th
130
q3h
1040
145.5
7.15
Results
From the moment Xiao Jiang was fed with human milk, seemingly magical effects were noted in this boy, with his fever subsiding and, petechiae and abdominal distension disappearing. At the same time, his skin color became pink, his sleep became better and longer, his ileostomy output decreased markedly and became yellow in color like a normal baby’s stool. More unbelievably, granulation tissue grew out and his abdominal rupture healed within one week and his weight increased rapidly from 5.5 kg to 7.15 kg within just 17 days. The seemingly magical changes are pictured below (Fig 3 and Fig 4) and documentedby the data in Table 1.
Discussion
The benefits of human milk in nourishing preterm infants have been sufficiently demonstrated in recent years. Since the first human milk bank was set up in 1909i?? milk banks have blossomed and grown rapidly in numbers in the past 30 years[7]. Pasteurized DHM has proved to be an important therapeutic resource in the care of preterm infants. Although the milk banks primarily serve the needs of sick preterm babies, DHM is also used for pediatric conditions such as metabolic disorders, immunodeficiencies, severe infections, severe allergies, failure to thrive, renal failure, various congenital conditions, postoperative therapy and cancer in adults [ 8-13]. In recent years, human milk banks have demonstrated remarkable growth, and clinicians have come to value the importance of DHM not only as a nutritional option but also a potentially life-saving therapy[14-19].
Similarly, we have seen the short-term beneficial and possibly lifesaving clinical effects in other diseased infants and children, especially children with complications after intestinal surgery, exemplified by the case presented here. Our traditional nutrition knowledge could not explain these surprising medical results. So, what is the mechanism? Obviously, there are many areas among the benefits of breast-feeding and DHM which we should study further. Breast milk contains all the nutrients needed for the growth and development of the infant. The protein, fat and calcium in breast milk are more easy for an infant to digest and absorb than the ones in other milks. This may explain why breast milk can save a malnourished, dying boy like Xiao Jiang. It is estimated that more than 900 infants/year may be saved in the United States if 90% of mothers exclusively breastfed for 6 months. In developing countries exclusive breastfeeding for 6 months is the most effective intervention, potentially preventing more than 1 million infant deaths/year [20].
Morever, breast milk is rich in substances that provide passive immunity to the baby, such as anti-infective factors, anti-inflammatory factors, immunomodulatory factors, hormones and multifunctional agents. Human milk it has been used as a home remedy for minor ailments, such as conjunctivitis, insect bites and stings, contact dermatitis, and infected wounds, burns, and abrasions. In 1990 Lucas et al. reported thatNEC was reduced significantly by breastfeeding premature infants, either exclusively or partially supplemented with either formula or pasteurized DHM [21]. From the case we report ,here, we can see the dramatic therapeutic effect against inflammation of surgical incisions.
Of course, we need more research on human milk and DHM to understand the mechanisms by which human milk protects ill children and how it promotes recovery and growth in these circumstances. Such research has the potential to contribute important new insights regarding the uniqueness and efficacy of human milk and the role of breastfeeding in infant development while also identifying novel mechanisms for disease prevention and treatment.
Conclusion
DHM is not only the best food for preterm infants and other ill babies when their own mother’s milk is not available, but also an important therapy for some severely ill children, such as severe post-operative malnutrition. We need more research to understand the mechanisms of the protection and therapeutic effects of DHM in such disease states.
