Donor Milk Research Articles

Human Milk Banking: An Ounce of Liquid Gold to Save a Life

Human Milk Banking: An Ounce of Liquid Gold to Save a Life

Effect of human milk-based fortification in extremely preterm infants fed exclusively with breast milk: a randomised controlled trial

Mortality and severe morbidity remain high in extremely preterm infants. Human milk-based nutrient fortifiers may prevent serious complications and death. We aimed to investigate whether supplementation with human milk-based fortifier (HMBF), as compared to bovine milk-based fortifier (BMBF), reduced the incidence of the composite outcome of necrotising enterocolitis (NEC), sepsis, and mortality in extremely preterm infants exclusively fed human milk. In this multicentre, randomised controlled trial at 24 neonatal units in Sweden, extremely preterm infants born between gestational week 22+0 and 27+6 fed exclusively human breast milk (mother's own and/or donor milk), were randomly assigned (1:1) to receive targeted fortification with either HMBF or BMBF. Randomisation was conducted before the enteral feeds reached 100mL/kg/day, and was stratified by enrolment site, gestational age, singleton/twin, and sex. The allocation was concealed before inclusion, but after randomisation the study was not blinded for the clinical staff. For the NEC diagnosis, the study group was masked to an independent radiologist, and the final assessment of NEC and culture-proven sepsis was done by a blinded consensus panel review. The primary outcome was the composite of NEC stage II-III, culture-proven sepsis, and mortality from inclusion to discharge, no longer than postmenstrual week 44+0, in the intention-to-treat population (ClinicalTrials.gov, NCT03797157). Between February 21st, 2019, and May 21st, 2021, 229 neonates were randomly assigned (115 HMBF, 114 BMBF). After exclusion of one infant due to parents' withdrawal of consent, 228 infants were included in the intention-to-treat analysis. Of the 115 infants assigned to HMBF, 41 (35.7%) fulfilled the criteria of either NEC, sepsis, or death, compared with 39 (34.5%) of 113 infants assigned to BMBF (OR 1.05, 95% CI 0.61-1.81, p=0.86). Adverse events did not differ significantly between groups. Supplementation with HMBF, as compared with BMBF, did not reduce the incidence of the composite outcome of NEC, sepsis, or death. Our results do not support routine supplementation with HMBF as a nutritional strategy to prevent NEC, sepsis, or death in extremely preterm infants exclusively fed human milk. ALF grant, Prolacta Bioscience, Swedish Research Council, and Research Council for Southeast Sweden.

Motivators and barriers to the acceptability of a human milk bank among Malaysians.

The World Health Organisation (WHO) recommends that all babies be exclusively breastfed, stating that donor milk is the next best alternative in the absence of the mother's own milk. Milk sharing takes many forms, namely wet nursing, co-feeding, cross-feeding, and a human milk bank (HMB). However, the establishment of a human milk bank is still not widely accepted and is a debatable topic because of religious concerns in Malaysia. The aim of this study is to determine the facilitators and barriers among Malaysians towards the acceptance of an HMB. A cross-sectional study with 367 participants was conducted; the participants answered an online-validated, self-administered questionnaire. Data on sociodemographic, knowledge on breastfeeding benefits, knowledge and attitude on HMB-specific issues were analysed in terms of frequency before proceeded with multiple logistic regression. The majority of the respondents were Muslim (73.3%), had completed their tertiary education (82.8%), and were employed (70.8%). Only 55.9% of respondents had heard of HMB, stating the internet as their main source of information, but many respondents were agreeable to its establishment (67.8%). Most respondents had a good score on knowledge of breastfeeding benefits and on HMB-specific issues (70% and 54.2%, respectively), while 63.8% had a positive attitude towards HMB. In the multivariate analysis, mothers with a good score on general knowledge of breastfeeding (AOR: 1.715; 95% CI 1.047-2.808) were more likely to accept the establishment of HMB, while being a Muslim was negatively associated with its establishment (AOR = 0.113, 95% CI 0.050-0.253). The study found a high prevalence of mothers who were willing to accept the establishment of HMB. By educating mothers on the benefits of breastfeeding, as well as addressing their religious concerns, the establishment of a religiously abiding HMB in Malaysia may be accepted without compromising their beliefs or the health benefit of donor milk.

Suficiência de leite humano para prematuros em Unidades de Terapia Intensiva

Abstract Objective To analyze human milk sufficiency in Neonatal Intensive Care Units in the Metropolitan Region of São Paulo according to the number of premature babies, estimated demand for human milk and actual consumption. Methods This is a cross-sectional study, carried out at Human Milk Collection Stations and Human Milk Banks registered with the São Paulo Network of Human Milk Banks in 2017. Data from 2017 census vital statistics were used to identify premature baby distribution in Regional Health Care Networks. Results 100% of Human Milk Collection Stations and 84.6% of Human Milk Banks in São Paulo participated in the study. Pasteurized human milk distribution insufficiency was identified between estimated demand and actual consumption by premature babies. During the study period, only the Center and Southeast regions met 100% of human milk coverage, followed by the Greater ABC region, with 44.62%. Conclusion Most Human Milk Collection Stations and Human Milk Banks in the metropolitan region of São Paulo do not assist all premature children. The management of these units can contribute to encouraging donor recruitment and collected human milk optimization.

Effect of holder pasteurization and storage of donor human milk on Bacillus cereus survival

Abstract Introduction Human milk, which constitutes the best composed nutrition for infants, is not a sterile biofluid. Besides nutritional and bioactive components, many microorganisms have been found in human milk, including Bacillus cereus. Those pathogenic bacteria can be responsible for causing pneumonia or septicemia in neonates. Although Bacillus cereus infections are not common, they represent one of the increasing factors of a high mortality rate in the preterm infants group. Donor human milk (DHM) may be a significant source of this pathogen. Materials and Methods Given the high ability of Bacillus cereus spores to survive under different thermal conditions, we tested the effect of the holder pasteurization and storage points (4 °C and −21 °C) on sporulation and vegetative forms’ survival in inoculated human milk samples by culture method and light microscopy. Results Studies confirmed that holder pasteurization is effective against vegetative forms of Bacillus cereus. Additionally, during storage endospores were observed in all analyzed inoculated donor milk samples, both the pasteurized and unpasteurized samples, thus possibly promoting the occurrence of Bacillus cereus in DHM. Conclusions Bacillus cereus is considered a contamination in DHM and in the human milk banks’ (HMB) environment. There is a need to further develop methods of identifying, transmitting, and preventing bacteria forming spores, which could be applied in HMB.

Retrato das mães doadoras e variáveis associadas à doação de leite materno em um Banco de Leite Humano

ABSTRACT Objective To describe and analyze the donor mothers’ profile and variables associated with breast milk donation at Human Milk Bank in the municipality of Guarapuava, Paraná, Brazil. Methods This was a cross-sectional study obtained from information contained in the donor registration form between the period July 2013 (implementation of the service) to December 2019. The collected data were tabulated and descriptive analysis of variables and Chi-square and Fischer’s exact association tests were performed. Results Of 1,491 records analyzed, this research identified that 70.73% of donors were between 20 to 34 years old; 67.69% had prenatal care at public health network and 61.37% have had cesarean delivery. Most mothers (61.44%) remained as donor for 29 days and 53.83% of them donated up to 500 ml of milk. In addition, statistically significant association was observed between milk volume donated and donation time for the following variables: prenatal place care, gestational age, child's birth weight, child age, and smoking. Maternal age was associated with a higher volume of donated milk. Conclusion The study's findings reinforce the approaching importance the possibility of human milk donation during prenatal care, with emphasis on private health service, and throughout the women's and children's health care network, as well as on the community.

Perceptions of Mothers with Preterm Babies towards Donor Breast Milk at Women and Newborn Hospital,Lusaka Zambia

Perceptions of Mothers with Preterm Babies towards Donor Breast Milk at Women and Newborn Hospital,Lusaka Zambia

THE EFFECT OF A DIET ON THE OCCURRENCE OF OCHRATOXIN A IN BODY FLUIDS

Background. Ochratoxin A (OTA), a secondary metabolite of fungi, is produced by fungi of the As pergillus and Penicillium genera. It is supplied to the body with food consumed by people. The purpose of this study was to determine the occurrence of ochratoxin A in human body fluids in relation to diet. A part of the study group consisted of women who were donors from a breast milk bank. The aim of this study was to determine the correlation of ochratoxin A in body fluids (milk, urine, serum) and the diet of the women covered by the study. The study material consisted of 60 urine samples, 60 milk samples and 60 blood samples. Ochratoxin A in milk and urine was determined by HPLC with fluorescence detection. For the determination of ochratoxin A in blood serum, we used a liquid chromatography-mass spectrometer (LC - MS/MS) method. Results and conclusions. As a result of the analysis, it was found that as the frequency of consump tion of dried grape fruit increases, there is a significant increase in the level of OTA in breast milk. Next, it was shown that as the frequency of beer consumption increases, there is a significant increase in the level of OTA in maternal urine. Finally, it was shown that a significant increase in maternal serum OTA levels occurs with an increase in the frequency of consumption of dried fruit. OTA was found in 4 out of 60 milk samples, in 40 out of 60 urine samples and in 60 out of 60 serum samples. The surveyed women’s average age was 31 (ranging from 22 to 41). Given all the respondents, 46 lived in the city, 14 in rural areas, 35 were economically active, 22 were not, and 3 were on maternity leave. On average, they had 2 children (from 1 to 4). Of all children being fed, 35 were male and 25 female. On average, delivery occurred on the 37th week of pregnancy (between the 27th and 42nd week).

Polyphenol analysis in human milk by a rapid, cost-effective, and accurate micromethod: translational development.

To develop a rapid method for analysing polyphenols, which are potentially active antioxidants against neonatal oxidative stress, from small human milk (HM) volumes. Acid and alkaline extractions were compared using two dyes: Folin-Ciocalteu and Fast Blue BB. Linearity, sensitivity, recovery percentage, polyphenol content, precision, and stability were assessed in 14 HM samples and compared using the Kruskal-Wallis H test (p<0.05). The best technique was applied to 284 HM samples to determine their polyphenolic content and its association with maternal diet by multifactorial linear regression. Acidic extraction successfully recovered the gallic acid reference standard, whereas alkaline extraction overestimated it. Calibration curves for all methods were linear (R2>0.96) up to 500 mg/L. All bicarbonate-based Folin-Ciocalteu methods assayed were stable and repeatable, whereas Fast Blue BB-based variants were not. HM polyphenols (mean=94.68 mg/L) positively correlated to the dietary intake of hydroxycinnamic acids, the most consumed polyphenolic family in this population. A bicarbonate-based Folin-Ciocalteu micromethod allowed the accurate determination of polyphenols in HM, which might be useful for translational research settings and HM banks.

Determinants of human milk donation: data from women donors at a milk bank

Determinants of human milk donation: data from women donors at a milk bank

Analyzing the Responses of Enteric Bacteria to Neonatal Intensive Care Supplements.

In the neonatal intensive care unit, adequate nutrition requires various enteral products, including human milk and formula. Human milk is typically fortified to meet increased calorie goals, and infants commonly receive vitamin mixes, iron supplements, and less frequently, thickening agents. We examined the growth of 16 commensal microbes and 10 pathobionts found in the premature infant gut and found that formula, freshly pasteurized milk, and donated banked milk generally increased bacterial growth. Fortification of human milk significantly elevated the growth of all microbes. Supplementation with thickeners or NaCl in general did not stimulate additional growth. Vitamin mix promoted the growth of several commensals, while iron promoted growth of pathobionts. These data indicate that pathobionts in the preterm gut have significant growth advantage with preterm formula, fortified donor milk, and supplemented iron and suggest that the choice of milk and supplements may impact the infant gut microbiota.

Food safety and the approach of the Human Milk Collection Center at the Hospital Zonal General de Agudos “Prof. Dr. Ramón Carrillo”

Introduction: Human milk banks are vital institutions for maternal and child health, promoting breastfeeding and neonatal care by processing and distributing donated breast milk. These banks contribute significantly to public and neonatal health by reducing medical complications and associated costs. In addition, they support maternal and child health policies, improving the quality of life of infants and reducing infant mortality. They are also fundamental for medical research on breast milk and its impact on infant health.Objective: To describe the implementation of a Critical Control Point analysis plan to ensure safe handling and increased volume of raw human milk.Methods: An observational and descriptive study was conducted in the milk bank, observing and documenting daily procedures and interviewing personnel. Internal documents were analyzed and a qualitative approach was applied to identify patterns and good practices.Results: Preventive and precautionary measures were implemented to ensure food safety, including Good Manufacturing Practices (GMP) and Standard Operating Procedures for Cleaning and Disinfection (SSOP). Critical points such as personnel hygiene and storage temperature were controlled. Traceability from donor to recipient was maintained, ensuring that raw and pasteurized milk was properly labeled. A health services network was established with the HIGA San Martin de La Plata Milk Bank to distribute pasteurized milk equitably.Conclusions: The HIGA Prof. Dr. Ramon Carrillo HIGA milk bank has been successful in maintaining food security and increasing the availability of raw and pasteurized human milk. Despite challenges such as a building renovation, a rigorous control of critical points has been maintained. Cooperation with the HIGA San Martin Milk Bank has facilitated the equitable distribution of pasteurized milk. This report highlights the success in ensuring food security and access to breast milk for the most vulnerable newborns.

Preterm Formula, Fortified or Unfortified Human Milk for Very Preterm Infants, the PREMFOOD Study: A Parallel Randomised Feasibility Trial

Objective: Uncertainty exists regarding optimal supplemental diet for very preterm infants if the mother’s own milk (MM) is insufficient. We evaluated feasibility for a randomised controlled trial (RCT) powered to detect important differences in health outcomes. Methods: In this open, parallel, feasibility trial, we randomised infants 25+0–31+6 weeks of gestation by opt-out consent to one of three diets: unfortified human milk (UHM) (unfortified MM and/or unfortified pasteurised human donor milk (DM) supplement), fortified human milk (FHM) (fortified MM and/or fortified DM supplement), and unfortified MM and/or preterm formula (PTF) supplement from birth to 35+0 weeks post menstrual age. Feasibility outcomes included opt-outs, adherence rates, and slow growth safety criteria. We also obtained anthropometry, and magnetic resonance imaging body composition data at term and term plus 6 weeks (opt-in consent). Results: Of 35 infants randomised to UHM, 34 to FHM, and 34 to PTF groups, 21, 19, and 24 infants completed imaging at term, respectively. Study entry opt-out rate was 38%; 6% of parents subsequently withdrew from feeding intervention. Two infants met predefined slow weight gain thresholds. There were no significant between-group differences in term total adipose tissue volume (mean [SD]: UHM: 0.870 L [0.35 L]; FHM: 0.889 L [0.31 L]; PTF: 0.809 L [0.25 L], p = 0.66), nor in any other body composition measure or anthropometry at either timepoint. Conclusions: Randomisation to UHM, FHM, and PTF diets by opt-out consent was acceptable to parents and clinical teams, associated with safe growth profiles and no significant differences in body composition. Our data provide justification to proceed to a larger RCT.

Probe sonicator as an effective alternative to inactivate pathogens and maintain in vitro antioxidant activity and α-tocopherol content in human milk

This study assessed the new technology of a high-intensity sonicator for processing of human milk comparing it with slow pasteurisation for effectiveness in inactivating pathogenic microorganisms and reducing the loss of antioxidant activity (AA). In the first stage, the effect of the diameter of glass vials on the effectiveness of ultrasound was evaluated and, subsequently, the effect of varying time and sonication amplitude in the inactivation of enteropathogenic Escherichia coli and Staphylococcus aureus in human milk. In the second stage, the effect of sonication on in vitro antioxidant activity was determined. Samples treated in the smaller diameter vials showed significantly greater decimal reductions. With higher amplitudes and the increase in sonication time there was a preservation of AA with the ultrasonic treatment, but with a shorter time span, which can lead to time and cost optimisation in human milk banks, in addition to significant decimal reductions in the pathogens evaluated.

Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya.

We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.

Nutritional and health effects of bovine colostrum in neonates.

High concentrations of immunoglobulins, bioactive peptides, and growth factors are found in bovine colostrum (BC), the milk produced by cows in the first few days after parturition. Various biological functions make it increasingly used to provide nutritional support and immune protection to the offspring of many species, including humans. These biological functions include cell growth stimulation, anti-infection, and immunomodulation. The primary components and biological functions of colostrum were reviewed in the literature, and the authors also looked at its latent effects on the growth and development of neonates as well as on conditions such as infections, necrotizing enterocolitis, short bowel syndrome, and feeding intolerance. The importance of BC in neonatal nutrition, immune support, growth and development, and gut health has been demonstrated in a number of experimental and animal studies. BC has also been shown to be safe at low doses without adverse effects in newborns. BC supplementation has been shown to be efficient in preventing several disorders, including rotavirus diarrhea, necrotizing enterocolitis, and sepsis in animal models of prematurity and some newborn studies. Therefore, BC supplementation should be considered in cases where maternal milk is insufficient or donor milk is unavailable. The optimal age, timing, dosage, and form of BC administration still require further investigation.

Operation Status of the Mutual Aid Human Milk Bank for Preterm Infants and Data Analysis [Response to Letter

Operation Status of the Mutual Aid Human Milk Bank for Preterm Infants and Data Analysis [Response to Letter

Rapid Versus Slow Cooling Pasteurization of Donor Breast Milk: Does the Cooling Rate Effect Melatonin Reduction?

Background and Objective: There is a question as to whether melatonin levels in breast milk are impacted by the cooling rate postpasteurization. Past research that has used in the Australian donor bank's breast milk Holder Pasteurization technique has reported varying findings regarding melatonin levels postpasteurization. Where breast milk was cooled slowly, a significant reduction in breast milk melatonin levels was observed. Conversely, where a rapid cooling method was used, there was no significant reduction in melatonin levels. The aim of this study was to investigate whether the cooling process between the different pasteurization techniques impact on melatonin levels in breast milk postpasteurization. Materials and Methods: Twenty-seven nighttime breast milk samples were collected, with each sample divided into three; one remained unpasteurized, one was pasteurized and rapidly cooled to 4°C, and the other was pasteurized and cooled slowly to 4°C. Results: Melatonin levels were significantly reduced in both the rapidly cooled and slow cooled breast milk samples when compared to their unpasteurized counterpart (p < 0.001). There was no significant difference in melatonin levels between the two cooling methods (p = 0.91). Conclusion: This study showed that both the rapid and cooling pasteurization processes had a similar reduction in melatonin levels in breast milk. However, even after pasteurization melatonin was still present. Therefore, it is recommended that donor banks still take into consideration circadian timing hormones such as melatonin and the time of day breast milk is expressed.

Improved outcomes after the introduction of donor breast milk

Premature infants are at considerable risk of increased morbidity and mortality. They have a higher risk of learning disabilities, cerebral palsy, sensory deficits, respiratory illnesses, and gastrointestinal illnesses.1,2 Providing mother's own milk to the preterm infant has nutritional, gastrointestinal, immunological, developmental, and psychological benefits. Breastfed preterm infants have a lower rate of ear infections, respiratory infections, or infection‐related events. They have lower rates of gastrointestinal infections, necrotizing enterocolitis, and mortality. When milk from the mother is not available, human donor milk is an important option, because it maintains many of its health benefits. This article shines light on the improved outcomes of premature infants after the introduction of donor breast milk and also discusses the multiple challenges faced by a level three NICU of a tertiary care hospital during the implementation of Donor Breast Milk program.

Inside the milk bank

Inside the milk bank