Human Milk Banking

 

Shweta Handa^1*, Rashmi Negi²

^1,2Assistant Professor, Faculty of Nursing, SGT University, Gurugram, Haryana

 

ABSTRACT:

Breast feeding is the best method of infant feeding because human milk continues to be the only milk which is uniquely suited to the human infant. India has the highest number of preterm deaths, the major cause of which is poor breastfeeding practices. According to WHO, breastfeeding can reduce infant mortality up to 80% as mother’s milk is the best source of nutrition for the baby. India faces its own unique challenges, having the highest number of low birth weight babies and significant mortality and morbidity in very low birth weight population. In India, the burden of low birth weight babies in various hospitals is about 20% with significant mortality and morbidity. Hence the Government health experts and the civil society must join hands to propagate the concept of human milk banking for the sake of thousands of low birth weight babies’.

 

 

 

INTRODUCTION:

Breast milk and nursing is an essential requirement for healthy growth and development of the newborn. During infancy, growth and development continues with the highest velocity and adequate and balanced nutrition is provided by breast milk of the mother for each baby ^[1]. The World Health Organization recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. Expressed pasteurized donor breast milk is not identical to fresh mother’s milk, owing to some loss of micronutrients and anti infective factors during pasteurization, decomposition over time and normal variations in the makeup of breast milk. Human milk bank is an organization that collects donated human milk, ensures milk safety and quality and makes it available for infants in need.

 

Studies have shown that use of donor breast milk provides cost efficiency in decreasing the problems of necrotizing enterocolitis, late onset sepsis and food intolerance ^[2].

 

The indications of Human milk bank are Prematurity-child who had taken birth before 37 weeks of completed gestation, babies whose birth weight is less than 1500gm, babies of mother with post partum illnesses, Severe IUGR, Feeding  intolerance –the babies who are suffering from congenital malformation of intestine, Babies who have undergone through any surgery, necrotizing enterocolitis, omphalocele, bowel obstruction, bowel surgery, temporary interruption of breastfeeding, babies whose mother died in the immediate post partum period^[3].

 

A mother’s milk cannot be substituted, especially for preterm babies who lack proper nutrition and need assistance and aid to resume to their pink of health. Mothers of premature babies produce breast milk which is formulated for preemie development. A mother with a preemie produces milk in accordance to the needs of the newborn which is slightly different in composition, as the body ensures to accommodate the nutrients which the newborn lacks. At least for the first two-three weeks a preemie mother’s milk will contain more protein, fat calories, calcium phosphorous, magnesium, zinc, sodium, and chloride than the normal mother’s milk designed to meet your baby’s particular needs. The premature milk is higher in protein and minerals that can be more easily digested and absorbed by the preemie.

 

The fat in human milk helps to enhance the development of the baby’s brain and neurologic tissues, which is especially important for premature infants. Human milk is much easier for a preemie to digest than formula and avoids exposing the newborn’s immature intestinal lining to the cow’s milk proteins found in premature infant formula. Premature babies who are breastfed are less likely to develop intestinal infections than are babies who are formula-fed, and to this effect there is ample evidence that breast milk improves survival and quality of survival in preemies .The milk a preemie’s mother produces in the first few days contains high concentrations of antibodies to help your baby fight infection. Even if your baby cannot breastfeed directly, yet expressing breast milk from the beginning will ensure that your milk supply is maintained until your baby is able to nurse. Unfortunately, there are mothers who are unable to express milk or lactate for their premature babies in need. It is therefore donated human milk alone which can save the day for these preemies. Mother’s of preemies are therefore urged to not only keep expressing their valuable ‘Premature Milk’ but also donate it when excess, and not throw away the gift that can save another preemie in need. Even for mothers whose babies are not able to breastfeed yet, you are recommended to not only continue expressing milk to maintain continued milk supply but also to donate the same. This generous gesture from your side can not only save another child but also keep you healthy – keeping you lactating maintaining a healthy supply. Expressed milk can be donated to a Human Milk bank which will screen this milk, pasteurize it and donate it to another premature baby who is not fortunate enough to get their own mother’s milk!

 

The criteria for donating human milk for the lactating women who are in good health, exhibiting good health related behavior, and not regularly on medications or herbal supplements (with the exception of prenatal vitamins, human insulin, thyroid replacement hormones, nasal sprays, asthma inhalers, topical treatment, eye drops, progestin-only or low dose estrogen birth control products, is willing to undergo blood testing for screening of infections has enough milk after feeding her baby satisfactorily and baby is thriving nicely. Lactating mothers who are not eligible for donating  human milk are the mothers Using illegal drugs, Smokes or uses  tobacco products or nicotine replacement therapy, who regularly takes more than two ounces of alcohol or its equivalent  per day or more than three caffeinated drinks (total of about 150 to 200 ml ) daily has high risk for HIV transmission, has a positive blood test result for HIV, Hepatitis B or C or syphilis, had a sexual partner at risk for HIV, hepatitis and venereal diseases in the past 12 months, has received organ or tissue transplant, any blood transfusion/blood product within the prior 12 months, is taking radioactive drugs, has chemical environmental exposure known to be toxic to the neonates and excreted in the breast milk, have active lesions of herpes or chickenpox on the breast. Women temporarily disqualified for the donation are the lactating women suffering from acute infection, including clinical mastitis and fungal infections of the nipple or breast. During the 4 week period following a case of rubella or varicella in the household starting from when the lesion crust over. During the one week period following a reactivation of latent infection with HBV or varicella zoster of the breast or thorax starting from when the lesions crust over, during the 12 hour period following consumption of alcohol. During the 8 days following donors or its partners had a tattoo administered in a regulated site using sterile needle and single use only dyes. During 28 days following donors receipt of live virus vaccine for measles, mumps and rubella. During the 3 months following receipt of any live virus vaccine including chickenpox, rotavirus, polio and typhoid.

 

The raw human milk is collected by either trained staff or the mother herself. It includes counseling the women and giving a donor card. Different containers used for collection and storage include: Polythene milk storage bags, hard plastic containers, Stainless steel containers, Glass containers. The steps of collection includes: washing hands before expressing, Make sure that all pump parts that come into contact with your skin or milk are sterilized. Otherwise, the pump will become a breeding ground for bacteria, and the milk will not be safe for the baby. Express milk and Store properly labeled (Date and Time) bottles provided by the bank in the refrigerator. The bottle can be filled till the time it is full ensuring 2cm gap and then place the bottle into the freezer within 24 hours of the first expression. Always tightly secure the lid without touching the inside. Once the bottle is full, immediately place the bottle in the coldest part of your freezer (-15°C to -20°C). When express milk for the next, Start with the fresh bottle with the label of Date and Time. And repeat the steps from 1 – 6. When starting with the last bottle please call the milk bank. Handover the frozen milk bottle(s) to the collector for transportation to the bank. The human milk is to be stored at room temperature of 150 to 20 Celsius for four to six hours or in the freezer compartment of the refrigerator for five to seven days. In the deep freezer it can be stored at the temperature of -200 Celsius for six months. Freshly expressed breast milk should be transported to the human milk bank at the earliest, preferably within two hours and should be stored in refrigerator or ice till it reaches the milk bank. The transport container used must be insulated, rigid, clean and disinfected, coolant blocks must be used in it and the empty space in the container must be filled with the bubble wrap. Human milk banking can be utilized by mothers undergoing through any major surgery / treatment, with no or insufficient lactation. In case of Adoption or surrogacy-because the surrogate mothers do not lactate, in case of abandoned neonates and sick neonates and for the babies of mother who cannot feed their babies.

 

Advantages of Human Milk Banking are: it offers families a chance to provide their child with reliable and healthy milk from other mothers. It helps matures the infant’s immune, digestive and neurological system. It improves intelligent quotient in children by 3 points, it prevents episodes of diarrhea and pneumonia. Human milk helps to support the immature immune system of a baby. Besides water, fat, lactose the three largest components of breast milk, it contains many things that help to fight against disease. It also consist human milk oligosaccharides. Human Milk Banks are cost effective and reduce the length of stay of the children in the hospitals. Another component of breast milk is lactoferrin, which tightly binds iron, making it unavailable to dangerous bacteria ^[4].

 

CONCLUSION:

Over 1.4 million children in India die under the age of five and almost fifty percent of those cases are babies under 28 days and this ‘liquid gold’ can save infants at the NICU. Human milk banks are a proven way to save babies. These banks offer families a shot at saving their child and providing their infant with a chance of a healthy life. According to WHO and UNICEF the use of human milk from other sources should be the first alternative when it is not possible for the mother to breastfeed. However religious drawback as well as concerns about the risk of disease transmission may be considered important obstacles in terms of operation of human milk banking system. The approach of the media in introduction of milk banking may be a solution to eliminate these obstacles. Efforts should be made to raise awareness and mothers should be informed about the importance of breast milk and breastfeeding so that milk banks can be regarded as an additional choice. In the initiations directed to milk banking, providing potential receivers information as much as possible by way of educating health workers including mainly midwives, nurses, gynecologists and pediatricians is important in strengthening the trust of individuals about donation safety ^[5].

 

REFERENCES:

1.     Bharadava, et al .Human milk bank guidelines: Indian Pediatrics. June 2015; 51:469-474.

2.     Eksioglu A, Yesil Y, and Turfan EC. Mothers’ views of milk banking: Sample of Izmir. Turkish Archive of Paediatrics. Jun 2015; 50(2): 83–89.

3.     Arslanoglu S, Moro GE, Bellu R, Turoli D, De NG, Tonetto P, et al. Presence of human milk bank is associated with elevated rate of exclusive breast feeding in VLBW infants. J Perinat Med.2013:41:129-31. Available from URL: www.iapindia.org. HBA 2015.

4.     Dr. Mallaiah Raghuram. Premature Milk- Need to spread a gift: Available from URL: http://amaara.org.in/index.php/2017/01/12/ premature-milk-need-to-spread-the-gift/

5.     Giirol A, Ozkan H, Celebioglu A. Turkish women's knowledge and views regarding mother's milk banking, Collegian 2014; 21(3):239-44. Available from URL: www.ncbi.nlm.gov/pubmed

 

 

Received on 07.03.2017           Modified on 26.07.2017

Accepted on 11.08.2017         © A&V Publications all right reserved