Human Milk Banking

Article by Sam Pearson

Most people agree that for the best start in life a baby needs mother‘s milk. But what happens when a mother has insufficient milk glands, has had past breast surgery or is taking medication (e.g. chemotherapy for cancer) and breastfeeding is not an option? What happens when a mother has an infection that could be spread to her baby through breastfeeding, such as HIV or hepatitis or a health problem that prevents her from breastfeeding? For these babies an alternative must be sought.

In past times, the practice of wet nursing provided an alternative to maternal breastfeeding for those who could access it. When a wet nurse was not available, milk from goats, sheep and other mammals was also used as substitute nourishment for babies. This often had fatal results.

When we consider alternatives to breastfeeding today most of us think of baby formula from a bottle. Wet nursing has virtually disappeared from the developed world, as methods of infant feeding with artificial formula milks have become relatively safe. However, the ideal alternative to maternal milk for a human baby is not from a can or a cow, but from a human.

In1980 at the World Health Assembly the WHO and UNICEF jointly declared: "Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in appropriate situations."

Many babies will not thrive without human milk. Infants with “failure to thrive”, formula intolerance, allergies and certain other medical conditions may require human milk for health and even for survival.

Sometimes a mother’s milk supply can be delayed. If a mother of a premature or adopted infant is not able to get lactation going quickly enough to meet the needs of their babies, donated milk can be used as a bridge until her supply is sufficient and in this way breastfeeding is protected.

The WHO/UNICEF Global Baby Friendly Hospital Initiative has since led to a revival of interest in milk banking. Human milk banks exist to provide human milk to needy babies for medical reasons where the natural mother is unable to breastfeed. Milk banks accept, store and redistribute donated human milk (DHM). Because babies who use donor milk are not related to the donors, every possible step is taken to ensure the milk is safe. All screening and testing of donor mothers and DHM is carried out by the milk banks who have guidelines which are reviewed regularly in light of current scientific and practical knowledge. The milk banks also play an important role in sharing information among experts on human milk, providing information to the medical community and encouraging research on the unique properties of human milk.

The history of milk banking.
After the industrial revolution, when wet nurses became difficult to find, human milk banking began. The first milk bank in the United States (US) was started in Boston in 1911 by two physicians who were concerned about the high death rate in an orphanage in their community. Over the next decades, advances in the dairy industry helped milk banks develop protocols for sterilising, pasteurising, storing, and freezing mothers’ milk. In 1943, the American Academy of Paediatrics published its first recommendations for operating human milk banks. A parallel human milk banking tradition arose in Europe, where infant formula was never embraced to the extent found in the US. In 1959, there were over 100 milk banks in Germany alone.

With aggressive marketing of infant formula, and especially since the onset of the AIDS epidemic, the number of human milk banks has declined.

Who donates the milk?
Donor mothers are volunteers (although some costs are covered) who make the effort to produce milk in excess of their babies needs. Some mothers donate milk because they are expressing for their own babies and find they have an excess of milk stored. Donor mothers are carefully screened in much the same way that blood banks screen donors to ensure that strict guidelines are met. Donors must have the consent of their doctor and their baby‘s doctor. They must be non-smokers, taking no medications, be in good health and must provide evidence of immunity to rubella, a negative syphilis test and provide their TB and herpes history. In addition, they must have negative blood tests for Hepatitis B and C, HIV 1 and 2, and HTLV 1 and 2. There are times when a donor may be required to withhold her milk temporarily.

How is the DHM collected?
A donor mother may express her milk by hand or using a suitably cleaned mechanical breast pump. Donor mothers are provided with breast pumps, collecting kits and instructed in hygienic methods of collection to protect the milk from contamination. Expressed milk is chilled or frozen and transported to the milk bank at regular intervals where it is thawed, cultured, and pasteurised.

How is the DHM processed?
Milk from a donor may be used raw, as is common in neonatal nurseries in Norway, or heat treated in order to kill any bacteria or viruses that may be present. While some of the components of human milk are heat sensitive and are destroyed during the heating process, a substantial number still remain functional in amounts higher than occur in formulas. Donor milk is tested for a range of potential pathogens before and after pasteurisation, and is only released for use if it meets the agreed standards. In the past 30 years, there has never been a documented disease or illness transmission through processed human milk.

Who receives the DHM?
Recipients are infants who have a medical need for human milk. Medical indications for supplementing the intake of a breastfed newborn infant at term include clinical hypoglycaemia, dehydration, and infection. Banked milk is also used for older babies and children in conditions such as formula intolerance, gastroenteritis, malabsorption, and postoperative nutrition. Milk banks help mothers provide breast milk for premature babies. "A systematic review and meta-analysis has reported that feeding with donor human milk was associated with a significantly reduced relative risk (RR) of NEC [3O]. Infants who received donor human milk were three times less likely to develop NEC (RR 0.34; 95% confidence interval (CI) 0.12-0.99), and four times less likely to have confirmed NEC (RR 0.25; 95% CI 0.06-0.98) than infants who received formula milk." (1)

Milk banks not only save lives but also save money. Of those babies who acquire NEC, up to 62% die from it. While 1.5% of premature infants fed mother’s milk acquire NEC, 10-17% of premature infants fed formula acquire this disease. Research shows that NEC will increase a baby’s length of hospital stay by two weeks.

Is human milk only for babies?
While the vast majority of breast milk is used to benefit babies and young children, DHM is presently being used to lessen infections among adults who have undergone liver transplants. Other important medical uses for this magical substance are being investigated.

How can you get DHM?
You need a doctor's prescription to receive donor milk, and each recipient of donor milk needs to be under medical supervision. After everything is set up, donor milk is picked up from the nearest milk bank, or it is shipped directly to the recipient. You do not need to live near a milk bank to receive donor milk.

How much does it cost?
Milk banks charge a fee to help offset the cost of processing DHM and this varies between milk banks (usually around 60% of the cost). Donor milk from a milk bank is covered by some medical insurance policies. It is also possible to approach the milk bank to find out how payment can be made later on, or how to get help with the payments.

Milk banks worldwide today.
In the United States there are seven dispensing and one research milk bank. The United Kingdom has twelve, endorsed by the British Paediatric Association. France has eighteen active milk banks and Canada has one. In Australia work is currently being done towards opening a large scale milk bank in Victoria and following a successful trial in Perth last year, the Perron Rotary Express Milk bank (PREM) will open mid-year at King Edward Memorial Hospital. The PREM bank will initially offer donor milk to premature babies in Western Australia, but there are hopes it
may eventually supply babies across Australia. Both milk banks are modeled on banks operating overseas.

Sam lives with her partner on Sydney's Northern beaches where she home schools her three children and runs a baby sling business www.earthslings.com. She is also the founder and co-ordinator of Sydney Attachment Parenting, a contact person for Home Education in NSW and a contact person for www.purebirth-australia.com

Reference

(1) RED Nova
Prevention of Necrotising Enterocolitis: Year 2004 and Beyond http://www.rednova.com/news/display/?id=146034&source=r_health

Human Milk Banking

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