Journal Article Review Epublish
PubMed: 42959462 DOI: 10.3389/fnut.2026.1926806
A scoping review of microbiological safety, bioactive components, nutrient retention, and feasibility of flash-heating expressed breastmilk: exploring potential use during infectious disease outbreaks.
Front Nutr 13:1926806
Authors: Helen Natalia, Carolina Guzman, Bindi Borg, Jodine Chase, Anna Coutsoudis, Kiersten Israel-Ballard, Karleen Gribble, Peggy Koniz-Booher, Mija Ververs
Affiliations
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
- SafelyFed Canada, Mississauga, ON, Canada.
- Department of Paediatrics and Child Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Department of Global Health, University of Washington, Seattle, WA, United States.
- School of Nursing and Midwifery, Faculty of Health, Western Sydney University, Sydney, NSW, Australia.
- Consultant, Baltimore, MD, United States.
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Abstract
INTRODUCTION
Infectious disease outbreaks can disrupt breastfeeding due to concerns about pathogen transmission through close contact or breastmilk. In these contexts, infants are often fed commercial milk formula or other breastmilk substitutes despite their known risks, which are exacerbated in low-resource settings. Existing technologies to inactivate pathogens in human milk, such as holder and high-temperature short-time (HTST) pasteurization, require specialized equipment and may not be feasible in emergency settings. Flash-heating (FH) is a low-cost, household-level alternative that approximates HTST conditions and can inactivate pathogens while preserving key nutritional and immunological components. This review examines the evidence on FH as a potential method for pasteurizing expressed breastmilk during infectious disease outbreaks.
METHODS
This scoping review followed the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Searches were performed in PubMed, Scopus, CINAHL, Embase, and Web of Science, supplemented by grey literature and forward citation searching. Studies on FH of expressed human milk were included if they evaluated on (1) microbiological safety, (2) preservation of nutritional and immunological components, and (3) feasibility in low-resource and outbreak settings. Two independent reviewers screened studies and extracted data using Covidence, and the evidence were descriptively synthesized.
RESULTS
A total of 24 studies published between 2005 and 2025 were included. FH is effective in inhibiting growth of a range of bacterial and viral pathogens. Effectiveness varies by pathogen type and heat sensitivity. FH preserves substantial proportions of key nutrients and immunological components in human milk, such as immunoglobulins, lactoferrin, vitamins, and oligosaccharides. Research and operational gaps remain regarding standardization, feasibility, and acceptability in real-world outbreak contexts.
CONCLUSION
Flash-heating shows potential as an option for enabling infants to be fed maternal breastmilk when direct breastfeeding and use of untreated breastmilk is not safe. Strengthening the evidence base will be essential to inform clear, context-appropriate guidance and support safe infant feeding practices during future outbreaks.
MeSH
Nutrients, Milk, Human, Milk, Safety, Disease Outbreaks, Breast Feeding, Food, Retention, Psychology, Pasteurization, Heating, Communicable Diseases, Infant