Abstract
If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID‐19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open‐ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic‐related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context‐dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies.
Highlights
If mother's own milk (MOM) is not available for low birthweight or otherwise vulnerable infants, donor human milk (DHM) from a human milk bank (HMB) is recommended by the World Health Organization (WHO), United Nations Children's Fund (UNICEF) (World Health Organization, 2011; World Health Organization/United Nations Children's Fund, 1980) and many national bodies (AAP Section on Breastfeeding, 2012; Arslanoglu et al, 2013; Mizuno et al, 2020) as the best option for achieving exclusive human milk diets and ensuring optimal nutrition.Throughout the COVID-19 pandemic, the use of DHM where breastfeeding was not possible has been promoted by the WHO (2020a)
Our findings showed that there was a huge response from potential milk donors to meet the need for increased DHM provision, HMBs have an ethical duty to ensure that donors are not coerced to give milk that may be needed for their own baby; the emotional drive to donate altruistically, which many donors express openly, should not override their own safety or that of their infants (Hartmann, 2017; Israel-Ballard et al, 2019)
Many HMB systems have struggled to respond to the COVID-19 pandemic, with issues deepened by the lack of globally agreed safety guidelines and rapid communications for emergencies, as well as limited data and infrastructure to ensure responsiveness during a crisis
Summary
If mother's own milk (MOM) is not available for low birthweight or otherwise vulnerable infants, donor human milk (DHM) from a human milk bank (HMB) is recommended by the World Health Organization (WHO), United Nations Children's Fund (UNICEF) (World Health Organization, 2011; World Health Organization/United Nations Children's Fund, 1980) and many national bodies (AAP Section on Breastfeeding, 2012; Arslanoglu et al, 2013; Mizuno et al, 2020) as the best option for achieving exclusive human milk diets and ensuring optimal nutrition.Throughout the COVID-19 pandemic, the use of DHM where breastfeeding was not possible has been promoted by the WHO (2020a). Milk banks are facing considerable challenges during the pandemic in maintaining the operation of services, alongside uncertainty in terms of which additional practices, if any, should be introduced into milk bank processes to maintain safety Many of these challenges are related to external forces, such as from the impact of national pandemic responses impacting donor recruitment, staffing numbers and logistics, lack of internationally agreed minimum standards, and increased demand related to the pandemic, rather than safety challenges. We aimed to estimate the scale of HMB services globally, outline the challenges facing provision of donor human milk in the context of a global pandemic, describe how HMBs worldwide are working rapidly together to mitigate them and highlight service vulnerabilities that require greater investment to ensure that exclusive human milk diets for vulnerable neonates can be maintained in this and future emergencies
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