Practicalities and benefits of human milk banks in India

Abstract

WHO describes exclusive breastfeeding as an unparalleled way of providing ideal food for the healthy growth and development of infants, and advocates it for six months [1]. In addition to providing protection against infectious and chronic diseases and lessening mortality from common childhood illnesses, it offers other psychological and practical advantages [1]. In India, 46.4% of postpartum women practice exclusive breastfeeding for sixmonths [2] comparedwith 16.3% in theUSA [3]. However, India has a higher infantmortality rate of 44 per 1000 [2] comparedwith 6 per 1000 in the USA. One of the preventable causes of infant mortality is unsterile top-up feedingwith formulamilk. This can be prevented by substituting top-up feeds with banked human milk. Artificial feeding is an important risk factor for infant morbidity and mortality, particularly for preterm neonates in low-resource countries [4]. The Cama and Albless Hospital in Mumbai has had a functional milk bank since 2008. Over the last six years, donatedmilk has benefited over 6000needy babies in the neonatal intensive care unit (NICU). The aimof the present study was to assess the impact that the milk bank has had on neonatal outcomes at the hospital. A retrospective study was carried out for the period January 1, 2008, to December 31, 2014. Ethics Committee approval was not required for the study and permission was granted by the head of the institute to access medical records from the NICU and the milk bank. Data were collected and analyzed to investigate the amount of milk collected and used since 2008, the decrease in neonatal morbidity and mortality since 2008, changes in the average duration of stay in the NICU for preterm and low birthweight neonates since 2008, and changing trends in milk donation in 2013 compared with 2008. The total amount of banked human milk collected since 2008 was 1 127 128 mL. Of this, 987 524 mL was consumed by 6084 NICU babies over six years. A reduction was found in the neonatal mortality rate from 4.7% in 2008 to 2.2% in 2013 (Table 1). Similarly, there was a decrease in the neonatal morbidity rate from 45.7% in 2008 to 23% in 2013. However, there was an increase in the duration of NICU stay for preterm and low birth weight infants, from 10 days in 2008 to 20 days in 2014 (Table 2). The total amount of milk collected in 2008 was 188 648 mL compared with 293 009 mL collected in 2013. Positive counseling and motivation of patients has led to a 55% increase in the amount of milk donated in 2013 compared with 2008. The reasons for the 53% decrease in neonatal mortality and 49.6% decrease in neonatal morbidity since 2008 are likely multifactorial, but the availability of banked human milk around the clock has played a significant role in these improved statistics. The average duration of stay in the NICU for preterm and low birth weight babies increased from 10 days in 2008 to 20 days in 2013. The reason for this is the decreased neonatal mortality rate for this group. Increased survival has led to an increased average stay as infants are only discharged from the NICU once their weight is greater than 1.8 kg. The cost of setting up the milk bank was approximately 300 000 rupees (approximately US $5000) and the annual maintenance cost for running the milk bank is approximately 10 000 rupees (US $150), excluding labor and electricity costs. For this minimal investment, every year over a 1000 needy babies benefit from banked human milk. Despite the minimal expenditure and immense benefits, there are only 10milk banks across India. Furthermore, all are in the public sector and are attached to government and teaching hospitals. Commercial milk banking, as seen in Colorado [5], is still a distant reality for India. Milk banks are cost-effective to maintain, create job opportunities, and have an immense cost–benefit ratio. The authorswish to emphasize the need for more milk banks across India.