The provision of donor human milk instead of formula is an important contribution to the nutrition and protection from infections for preterm infants. Systematic reviews suggest a lower risk of necrotizing enterocolitis with pasteurized donor human milk (PDHM) as opposed to artificial formula, although evidence supporting PDHM use from randomized control trials is limited. Human milk banks (HMBs) must have a risk management system to maintain a safe product especially as many operate in an unregulated environment. To ensure safety, the HMB in Australia has committed to meet the appropriate standards recommended in the Code of Good Manufacturing Practices (Blood and Tissues) and models risk management during processing on Codex HACCP (Hazard Analysis Critical Control Point) requirements. There is scope to continually reevaluate the screening of donors and quality standards recommended during HMB. This will be most effective if strong networks of HMBs are developed with regional reference laboratories to encourage compliance with safety guidelines. Further research and development is needed to refine technology for treating donor milk such as thermal ultrasound and ultraviolet light, aimed at the retention of full bioactivity. HMB networks will facilitate collection of evidence for refining HMB practice which should translate to improved outcomes for preterm and sick infants. Cost effectiveness is most likely when HMBs are associated with large neonatal intensive care units.
Food habits, an integral part of all cultures, have their beginnings during early life. This chapter reviews the development of the senses of taste and smell, which provide information on the flavor of foods, and discusses how children's innate predispositions interact with early-life feeding experiences to form dietary preferences and habits. Young children show heightened preferences for foods that taste sweet and salty and rejection of that which tastes bitter. These innate responses are salient during development since they likely evolved to encourage children to ingest that which is beneficial, containing needed calories or minerals, and to reject that which is harmful. Early childhood is also characterized by plasticity, partially evidenced by a sensitive period during early life when infants exhibit heightened acceptance of the flavors experienced in amniotic fluid and breast milk. While learning also occurs with flavors found in formulae, it is likely that this sensitive period formed to facilitate acceptance of and attraction to the flavors of foods eaten by the mother. A basic understanding of the development and functioning of the chemical senses during early childhood may assist in forming evidence-based strategies to improve children's diets.
Cow's milk is a major food for young children. Whole cow's milk is known to be detrimental to infants, mainly due to its low iron content. The negative association with iron status led to recommending the introduction of formula feeding in infancy during the weaning period or when breastfeeding ceased. More recently, the literature suggests that consuming whole cow's milk in infancy has unfortunate effects on growth, especially weight acceleration and development of overweight in childhood. These issues are discussed in the following chapter. Other suggested reasons for the avoidance of whole cow's milk in infancy are touched upon, such as milk protein allergy and high renal solute load. The hypothesis about early cow's milk introduction in the pathology of certain diseases, mainly through the peptide beta-casomorphin-7, is briefly reviewed, showing that there is no clear evidence for the suggested associations. The chapter gives a recent example of introducing formula at 6 months of age instead of whole cow's milk in infants' diet in Iceland. Several aspects of consuming whole cow's milk in infancy can be found in recent reviews. Copyright (C) 2011 Nestec Ltd., Vevey/S. Karger AG, Basel
