FLASH HEAT METHOD

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FLASH HEAT METHOD

• ONE OF THE MOST DIFFICULT DILEMA S FACED BY
  WOMEN WITH HIV IS THE DECESION WHETHER TO BREAST
  FEED THEIR BABIES OR NOT

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• More than 90 of babies with HIV have acquired it
  through MTCT.

• It is estimated that 750,000 babies world wide
  become infected with HIV each year and most of
  these are in sub-Saharan Africa

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• The rate of MTCT varies
• In the absence of specific
  intervention
• The rate of MTCT is approximately 15 to
  20.
• With prolong breast feeding over 6 months the
  rate is doubled 35 to 40

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• In developed countries MTCT has been eventual
  decreased by 1 to 2 through availability of
  ARV,S and exclusive formula feeding
• In countries with limited resources the use of
  formula increase the risk of mortality rate
• due to severe diarrhoea malnutrition.

• According to a WHO report published in 2006, it
  is estimated that1,45mllion children under 2yrs
  of age are lost per annum due to suboptimal
  breastfeeding or infant feeding practices

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• Mothers who are HIV positive with limited
  resources who do not meet AFASS criteria
• Feeding option is
• Exclusive breast feeding for the 1st 6months or
• Flash heat expressed breast milk from birth
• Breast milk has optimal nutrition ,
  immunological properties that protect the
  epithelial lining of the gut ,preventing
  conditions ,eg necrotising enterocolitis
  especially premature neonates.

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Afass criteria

• Acceptabiity- is eff acceptable for the mother?
• Feasibilty- is the mother able to begin eff
  correctly for the required six months period of
  time?
• Affordability- is the mother able to afford the
  cost of eff?
• sustainabiity- will the mother be able to
  continue with eff for the recommended 6month
  period, once she has begun?
• Safety- will the mother be able to practice eff
  safely?
• Eff excusive formula feeding
• Refer to SA national PMTCT policy released in
  Feb 2008 (see page 49)

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5 AFASS CRITERIA
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FLASH HEAT METHOD

• Quick, simple and safe method of pasteurizing EBM
• Eliminates viral activity and destroys bacterial
  contamination.
• Nutritional losses are significantly less than
  prolong heating method approximately
• 20-30
• Has been community tested in Mayville, KZN.

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FLASH HEAT METHOD

• Step 1 wash hands with warm water and soap

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Flash heat method

• Step 2
• breast milk is to be hand expressed
• into a glass jar(250ml)
• N.B. not more than 100ml to 120ml expressed
  breast milk (EBM)

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FLASH HEAT METHOD

• STEP 3
• The jar containing EBM, needs to be closed with a
  lid, until it is ready to be heated
• when ready to heat the EBM, remove the lid from
  jar.
• Place the jar in a small aluminum pot(1,5L).

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FLASH HEAT METHOD

• Step 4
• pour cold water into the pot (not the jar).
• The level of water in the pot must cover the
  level of the EBM in the jar by 2 fingers widths.

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FLASH HEAT METHOD

• Step 5
• Place the pot containing the jar, on the stove/
  heat source and bring to boil

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FLASH HEAT METHOD

• Step 6
• once the water is rapidly boiling, remove from
  heat.

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FLASH HEAT METHOD

• Step 7
• If for immediate use, then close jar with lid and
  run under cold water to cool milk.
• Then leave the jar closed, and keep it for 6-8
  hours(at room temperature)

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FLASH HEAT METHOD

• STEP 8
• Milk is to be fed per cup and spoon or per
  feeding cup or per nasogastric tube

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PROCEDURE OF FLASH HEATING
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FLASH HEATING METHOD

• RVD positive mothers who opt to flash heat EBM
  from her infants birth, will continue to express
  and flash heat EBM, upon discharge from
  hospital.
• However, if mothers find this too demanding
  because the milk volume needed will be increasing
  with the infants increase in age and weight, and
  if the AFASS criteria are not satisfied, then
  mothers can return to feeding directly from
  breast (exclusive breastfeeding) till the baby is
  6months, then if the baby is RVD VE, to continue
  flash heating EBM.

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MIXED FEEDING

• Combination of feeding of breastfeeding and
  formulae feeding should strictly be avoided
• If breast milk remains for a prolonged period in
  the breast, this increases the concentration of
  HIV in the breast milk, significantly increasing
  the risk of MTCT.

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WHEN DO WE START

• Many of the things we need can wait.
• The children cannot.
• To them we cannot answer tomorrow.
• Their name is today.
• Gabriela Mistral, Chile
• Nobel Price For Literature,1945

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FLASH HEAT METHOD

• Further reading
• Chantry J et al, 2000, JAIDS,24325-329
• Israel- Ballard K et al,2007, Acquir Immune Defic
  Syndr, 45 (3)318-323
• Israel- Ballard k et al, 2006, J Trop Ped, 52(6)
  399-405

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• Thank you