A scoping review of microbiological safety, bioactive components, nutrient retention, and feasibility of flash-heating expressed breastmilk: exploring potential use during infectious disease outbreaks

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.

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.

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.

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.