The Lifesaving Impact of Donor Breast Milk Banking

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The Lifesaving Impact of Donor Breast Milk Banking

In the delicate journey of infancy, every drop of nourishment matters. For countless newborns
worldwide, access to breast milk can be a matter of life and death. 

However, not all infants have the privilege of receiving this vital source of nutrition from their biological mothers. This is where the remarkable initiative of donor breast milk banking steps in, offering a beacon of hope for vulnerable babies and their families.

We already know that exclusive breastfeeding practices can reduce infant mortality by 13% in low-income countries (WHO, 2021).

“Exclusive breastfeeding (EBF) is the most cost-effective intervention to reduce infant morbidity and mortality worldwide"

The importance of exclusive breast milk feeding to vulnerable infants

For a multitude of reasons, infants born sooner than 36 weeks gestation have a higher risk of
infection as well as poor feeding abilities (Archives of Disease in Childhood, 2018). 

Adding to this already vulnerable state, they have increased nutrient requirements to help them grow at
the same rate as they would have inside the womb (Frontiers in Pediatrics, 2020). We have strong evidence which indicates that human milk (HM) is the best source of nutrition for both term and preterm infants, conferring health benefits both in the short and long-term.

Mothers to preterm infants produce milk that has higher levels of energy, lipids, protein, nitrogen, fatty acids, some vitamins and minerals, immune and anti-inflammatory factors. Providing these vulnerable infants exclusively with breast milk reduces the risk of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis, chronic lung disease, retinopathy of prematurity, neurocognitive delays, and readmission after NICU discharge. Premature infants have a 6-10 times reduced risk for NEC with human milk, compared to formula feeding. 

This is greatly attributed to the fact that human milk contains numerous immune modulating, live cells
to protect against infection (Frontiers in Pediatrics, 2020).

The World Health Organization has developed an infant and young child feeding hierarchy to
illustrate the preferred milk options for infants. As you may notice, donor breast milk is the first
choice for premature infants, if the mother’s own milk is not available.

Figure 1: Infant feeding hierarchy (WHO, 2009)

Some of the major barriers in provision of mother’s own expressed breast milk in NICUs are as follows:

  • Physical separation from infants.
  • Maternal health issues.
  • Local breast issues like sore nipple, engorgement, mastitis, etc.
  • Stress of baby being in NICU.
  • Difficulties related to expressing milk like unavailability of proper breast pump, storage facilities and lack of privacy, etc.
  • Lack of knowledge on subject.
  • Lack of family support.
  • Mother is not on the hospital premises.
  • Lack of proper counseling from health personnel.

"Human milk banking is a resource intensive process. The machinery alone can amount to $10,000 to $60,000.."

It is with circumstances like these that we can rely on donor breast milk to provide these vulnerable infants with safe and nutritious feeding when the mother’s own milk is not sufficient or available.

The provision of donor human milk to those infants most in need has been shown to improve infant health and survival as well as reduce the cost burden on the health care system. It can reduce Necrotizing Enterocolitis (NEC) incidence from 10% to 1.5% through the use of donor milk, while saving many thousands of rand daily through fewer surgeries and decreased length of hospital stay.

“The term Milk “Bank” is perfect – it simultaneously describes the safety and the value of donated milk.” Dr. Alan Horn – Neonatologist at Groote Schuur Hospital

What is Donor Breast Milk Banking?

Donor breast milk banking involves the collection, processing, and distribution of breast milk donated by lactating mothers to infants who are unable to receive sufficient breast milk from their own mothers. This milk is carefully screened, pasteurized, and stored to ensure its safety and efficacy in nourishing premature or ill infants.

To ensure the safety of the donated breast milk, all applicants are required to complete a series of screening questions and tests, which might include the following:

  • Is the donor in good health?
  • The donor should not have any high-risk lifestyle behaviors.
  • The donor must be tested for HIV, syphilis, hepatitis B, and other infectious diseases, which is repeated after 3 months – positive mothers are not eligible to donate.
  • Women who obtained piercings, tattooing, or traditional scarification in the preceding 12 months cannot participate.
  • Donors must be nonsmokers, must limit alcohol intake in the 24 hours before donation, and must avoid taking any medications contraindicated with breastfeeding.

Once a mother has passed the screening process and is eligible to donate, she will be guided to ensure safe handling and storage of her milk, before it reaches the breast milk bank. These guidelines might include the following:

  • Appropriate hygiene, including handwashing and sterilization of breast pumps and containers.
  • Provision of glass jars or hard plastic containers that are deemed to be safe.
  • Instructions on labeling of containers with the donor details and expression date.
  • She requires a properly working freezer for immediately freezing milk after it is expressed or pumped.
  • She will be required to safely transport the milk to the milk bank or depot via secure cool boxes packed with ice packs.

How to ensure donor breast milk is safe

The next step of Donor breast milk banking is to pasteurize the milk. This is another safety element so ensure that any harmful viruses and bacteria are eliminated before the milk can reach the recipient baby. 

Figure 2: Process to ensure safety and quality of donor milk. HMBASA 2011

The gold standard for donor human milk pasteurization is the holder method. This method requires the milk to be exposed to a temperature of 62.5◦C for 30 minutes and then rapidly cooled. From there a small sample of milk is sent to a laboratory for microbiological testing to determine if the bacterial count is within acceptable limits. If so, the frozen milk can be dispensed to a recipient baby.

For those of you who don’t know, I used to work as the Clinical Manager at Milk Matters Donor Breast Milk Bank in Mowbray, Cape Town. I was able to work with this entire process, from screening the donors, to pasteurizing, to issuing milk for recipient babies. I have experienced firsthand the difficulty in deciding whether we could supply donor breast milk to a baby in need, or not. 

Besides having to follow strict criteria, we had to evaluate our supplies daily to allow us to prioritize the milk for the most vulnerable babies. These criteria included babies who were born prematurely, under 1.5kg as well as babies who were severely ill, whose mothers could not supply enough of their own milk or any at all. Having to refuse a baby from getting this life-line milk because of limited supply, was one of the most debilitating things I have had to do in my career.

The sad thing is that so few people know about breast milk banking. Most of us know that we can donate our blood, but donating breast milk is limited to lactating woman who have a surplus in supply above their own infant’s needs. To add insult to injury, human milk banking is a resource intensive process. The machinery alone can amount to $10,000 to $60,000, disposable items are required to maintain safety and hygiene, plenty of freezers and durable containers all add to the cost of the operation.

So, now that you know more about Donor Breast Milk Banking, I urge you to talk about it, promote it and support a breast milk bank however you can. Yes, they will always need more donated breast milk, but donating funds can help them expand their reach to more prospective donors and maintain their vital operations.

Final Thoughts on Donor Breast Milk

Donor breast milk banking represents a powerful testament to the innate compassion and generosity of humanity. It serves as a reminder that by working together, we have the ability to nurture and protect the most vulnerable lives among us. As we celebrate the remarkable achievements of donor milk programs, like Milk Matters, let’s aim to improve our own efforts to help ensure that every infant has the opportunity to thrive, one precious drop of milk at a time.

By Carene Joubert

March 2024

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