The Human Milk Bank: An Untold Story

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A human milk bank, also known as a breast milk bank or lactarium, is a facility that gathers, tests, processes, and dispenses human milk that has been donated by nursing mothers who are not the recipient infant's blood relatives. If at all possible, nursing during the first year provides newborn babies with the best nourishment.

Human milk banks provide a solution for mothers who are unable to breastfeed their children due to various circumstances, such as the baby being at risk of contracting certain diseases from the mother, or the baby being hospitalised at birth due to very low birth weight (and thus at risk for conditions like necrotizing enterocolitis), and the mother being unable to supply her own milk during the prolonged stay due to circumstances like living far from the hospital.

Premature infants are the main and by far the most significant category of users of human breast milk. This type of milk may also be given to infants who have digestive or metabolic issues. When a woman is unable to supply her own milk, human breast milk serves as a replacement in place of formula. Toddlers and kids with medical issues such as treatment for cancer and growth failure while on formula can also be offered human breast milk.

Human Milk Bank is supplied for:

Absent or inadequate lactation: Mothers who have had many births and are unable to produce enough breastmilk for their newborns initially.

For infants of non-lactating mothers, adoptees of newborns, and in cases when inducing lactation is not feasible.

Newborns in need of care and unwell newborns.

Temporary interruption of breastfeeding.

The biological mother's breast milk puts the infant's health at risk.

Children whose mothers passed away shortly after giving birth.

There are myriad reasons a newborn may not be able to breastfeed including:

Babies who are born prematurely are frequently quite weak and may lack the strength to nurse on their own.

Even healthy newborns can have trouble latching and finding it challenging to breastfeed.

Breastfeeding may be challenging for mothers or even unpleasant for them.

Mothers may have trouble producing enough milk, and they may find it difficult for breast milk to fully sustain the baby's growth on its own.

After lengthier or more difficult deliveries, mothers might not be able to nurse their babies.

It's possible for mothers to be taking medication or have underlying health issues that make nursing unhealthy for both the mother and the child.

For whatever reason, infants who are taken away from their mother will require additional support feeding.

History:

The greatest way to feed a baby is through breastfeeding because human milk is still the only milk that is specifically formulated and best suited for a baby. It should be encouraged for all moms to breastfeed their children. When a mother is unable to nurse her child directly for some reason, her breastmilk should be expressed and given to the child. The next best choice is to use pasteurised donor human milk if mother's own milk is unavailable or insufficient (PDHM). Due to its high rate of low birth weight infants and high rates of mortality and morbidity among its very low birth weight (VLBW) population, India has special difficulties. About 20% of all newborns in our nation's hospitals have low birth weights, which is associated with considerable mortality and morbidities. These infants' risk of infection can be greatly decreased by breast-feeding them. To help the thousands of low birth weight and preterm babies, the government, medical professionals, and civil society must work together to spread the idea of human milk banking.

Wet nursing is believed to be the origin of breast milk donation. The Babylonian Code of Hammurabi has the earliest mention of rules governing the sharing of breastmilk (1800 BCE). The long-held assumption that infants pick up qualities from their nurses through their breast milk served as the inspiration for these laws. European culture began to view breastfeeding as immoral in the 11th century, which caused wet nursing to become a widespread practice among Europe's nobility and aristocracy. Wet nursing was less common by the 19th century as a result of worries about nurses' unhealthy habits. As a result, scientists in the medical field started looking at how alternative nutrition affected newborns.

From 1902 through 1911, Theodor Escherich of the University of Vienna performed research on the impact of various nutrition sources on newborns. His research showed that compared to neonates fed in other ways, breastfed newborns had considerably different gut microbes. Escherich established the first human milk bank in 1909. The first milk bank in the United States started the following year in the Boston Floating Hospital. Dr. Armeda Fernandez established the first milk bank in Asia under the name Sneha on November 27, 1989, in Dharavi, Mumbai. Currently, there are over 14 human milk banks (HMB) spread out across India.

Due to recent developments in newborn care and infant formula, milk banking decreased in the 1960s. Despite these recent developments, the World Health Organisation and the United Nations Children's Fund continued to hold the view that donor breast milk is the ideal replacement for mother's breast milk in 1980. With the HIV epidemic, milk banking usage further decreased. When strict screening became necessary, the expense of running milk banks grew, forcing many to close.

The practice of wet nursing traced back to the mythological times, but in India, modern human milk banking is still in its infancy. Some of the same causes include a lack of awareness, a leadership gap, high infrastructure and maintenance expenditures, and a shortage of neonatal setups. The industry's promotion of formula milk was one of the main causes of the lack of interest in human milk banking. There is a need to develop human milk banks in all level II and level III facilities in light of the difficulties involved with formula feeding to the ill, tiny preterm neonates, and mothers' incapacity to breastfeed in the initial period. In order to achieve this goal, it was felt that rules for the development and operation of human milk banks in our nation were necessary. These recommendations are an effort to support the formation and management of human milk banking with scientific methodologies rather than to present comprehensive scientific material. However, modern screening techniques and procedure uniformity have made donated milk a competitive alternative to mother's breast milk. Since breast milk can be pasteurised and preserved for up to 8 months, milk banking may become a significant global business.

Donors for Human Milk Bank:

Healthy nursing moms with healthy infants who voluntarily agree to donate surplus breastmilk for other newborns without compromising their own infant's nutritional requirements make up the donor population. The donors can be lactating members of the hospital staff, women whose infants are receiving care in neonatal critical care units, moms who have lost a baby but are willing to donate their milk, mothers who regularly attend well-baby clinics, and motivated mothers from the community. For their gifts, donors are not compensated.

Try to utilise several channels to contact the largest possible donor base. Donors may be encouraged by raising public knowledge of the possibility of breastmilk donation through a variety of channels, including mass media. A positive role can be played by NGOs, social clubs, and college students.

Criteria For Breast Milk Donors:

Who can donate:

A lactating woman who:

is considered to be in good health, exhibiting good health-related behaviour, not regularly taking medications or herbal supplements (with the exception of prenatal vitamins, human insulin, thyroid replacement hormones, nasal sprays, asthma inhalers, topical treatments, eye drops, and progestin-only or low dose oestrogen birth control products),

is willing to submit to blood testing for infection screening, and

has enough milk after successfully breastfeeding her child.

Who cannot donate:

A donor is ineligible if they have one of the following:

uses illegal drugs, tobacco products, or nicotine replacement therapy;

regularly consumes more than two ounces of alcohol or its equivalent or three caffeinated beverages per day;

has a positive blood test result for HIV, HTLV, Hepatitis B or C, or syphilis;

has HBV, HIV, HCV, or venereal disease(s) or either one has high risk behaviour for getting these in the recent 12 months.

having mastitis, a fungal infection of the nipple or areola, active herpes simplex or varicella zoster infections in the mammary or thoracic region,

having exposure to chemicals in the environment or over-the-counter medications or megadoses of vitamins, all of which are known to be toxic to the newborn and excreted in breastmilk.

has received an organ or tissue transplant, any blood transfusion, or any blood product during the previous 12 months.

Health Benefits of Human Milk Bank:

Human milk banks give parents the opportunity to give their children reliable, nutritional milk from other mothers. The need for human milk banks can be seen in the fact that these facilities provide milk that is mostly consumed by kids whose moms are unable to provide them reliable milk.

In the current world, donated breast milk is a crucial component of maternity care. Access to donor milk enables infants who are unable to breastfeed to receive all the essential nutrients and distinctive advantages of human milk, supporting their immune systems, growth and development, and general health and wellness.

Experts advise donating breast milk over formula because donated milk contains a variety of nutrients and substances that formula milk does not have, such as:

Beneficial microorganisms that safeguard the digestive system of infants

Hormones that foster intimacy, control appetite, and establish regular sleeping patterns

Enzymes and immunoglobulins (antibodies) that support the infant's immune system

the development of the baby's brain, neurological system, and eyes using long-chain fatty acids

Prebiotic oligosaccharides that promote intestinal health

Potentially helpful stem cells for organ development.

Human Milk Bank Administrative Staff:

A team of experts should be assembled by human milk banks to direct their entire growth and operation. It may include experts in lactation, microbiology, nutrition, public health, and food technology, as well as paediatrics/neonatology. It should consists of:

a director (for organising, implementing, and evaluating the services),

a milk bank officer (typically a doctor, for managing the bank's daily operations and training),

lactation management nurses (for assisting mothers in expressing breast milk and providing counselling),

a milk bank technician (for pasteurising breastmilk and monitoring microorganisms),

a milk bank attendant (for collecting, sterilising the containers, and upholding hygiene), and

a receptionist (for answering calls)

a microbiologist (for microbiology testing and infection control policies).

Process Performed by Human Milk Bank:

Collection: The donor is directed to the designated breastmilk collection area in the milk bank or in the milk collection centre after receiving the proper counselling, determining their suitability for donation, obtaining written informed consent, taking their history, getting a physical examination, and collecting samples for laboratory tests. After the donor selects an expression technique for their breastmilk, professional staff collects the milk while taking hygienic precautions. Currently, in our nation, it is best to avoid collecting breast milk at home owing to the possibility of contamination. Before expressing, washing the breast with water is just as effective as washing with disinfectant.

Breast pumps or manual hand expression can be used to express breastmilk. Manual expression is a simple, efficient, and contaminated-risk-reduced form of expression. In breastfeeding mothers, simultaneous breast expression is more effective than sequential breast expression. Milk must be collected in sterile containers that are appropriately labelled and transferred to Human Milk Bank (HMB) in a cold storage environment.

Processing: Raw breastmilk should be refrigerated until the serological report comes negative and should not be added to frozen milk. Microbiological screening of donor milk is done before and after pasteurisation, and no growth is acceptable in post-pasteurisation microbiology cultures. Whole batch of culture positive containers of pasteurised milk should be discarded.

Storage: Pasteurised milk should be stored in a dedicated freezer or freezer area while being careful not to distribute it until the culture results are negative. The same container used for pasteurisation should also be utilised for storage. Transferring pasteurised milk in other containers is not advised due to the possibility of contamination. Culture-negative processed milk should be stored at -20°C in a container that is well sealed and clearly marked with the expiration date and other pertinent information. It can be kept for three to six months. Prior to distribution, random cultures of preserved milk can help with quality control.

Disbursal: PDHM (Pasteurised donor human milk) should be disbursed at physician's requisition after informed consent from the parents of the recipient, preferably from preterm donors, and should be done on a First-in-first-out basis. Frozen PDHM should be thawed by either defrosting rapidly in a water bath at a temperature not exceeding 370C, or under running lukewarm water. Milk should not be refrozen after being thawed as it increases the hydrolysis of triglycerides. It should be used within 3 hours to prevent contamination.

Labelling and Record Keeping: HMB (Human Milk Bank) should ensure full traceability from individual donation to recipient and maintain a record of all storage and processing conditions. Proper labelling should be water resistant and names and identifying details of donors, dates of pasteurisation, batch numbers and expiry date should be clearly readable. Record keeping should be meticulous for Donor Record File and PDHM Disbursal Record File.

Human Milk Banks Around the World:

India:

Armida Fernandez founded Asia's first milk bank in 1989 at Sion Hospital in Mumbai, India; it is now managed by neonatologist Jayashree Mondkar.

At Lady Hardinge Medical College, the Vatsalya-Maatri Amrit Kosh, the first milk bank, was founded in 2017. It was founded as a part of the Norway-India Partnership Initiative in cooperation with the Norwegian government and Oslo University (NIPI).

Yashoda Human Milk Bank was founded in September 2013 at the D. Y. Patil Medical College, Hospital and Research Centre in Pimpri, Pune, Maharashtra. It is the first human milk bank established in a private medical college in India and was founded with the help of the Rotary Club of Nariman Point, Mumbai. On January 31, 2019, a sophisticated human milk bank and the Comprehensive Lactation Management, Training and Research Center (CLMTRC) were formed.

The Rotary Club Of Amravati Midtown established the first human milk bank in Central India in 2016 at the Dr. Panjabrao Deshmukh Medical College in Amravati. At the moment, it has 3 units.

Africa:

Chinny Obinwanne, a lactation expert and physician, established Milk Bank Nigeria.

Milk Matters, a breast milk distribution and collection organisation in South Africa, is headquartered in Cape Town.

Brazil and Latin America:

Brazil is regarded as having the most economically advantageous milk banking system in the world, with a vast network of 217 milk banks. Brazil's newborn mortality rate has decreased 73% since the first milk bank opened in 1985, in part as a result of milk banks becoming more widely used. Breast milk from over 166,000 moms was donated in 2011 and fed to nearly 170,000 infants, totalling 165,000 litres (5,580,000 fl oz). These initiatives are coordinated by the Ibero-Brazilian Network of Human Milk Banks. Each donor undergoes a screening process; in general, they must be in good health and not be using any medications. The Brazilian technique, which has expanded to nations like Spain, Portugal, the Cape Verde Islands, and parts of the rest of Latin America., is known for its low-cost pasteurisation of milk.

North America:

The "Criteria for the Establishment and Operation of a Donor Human Milk Bank" by the Human Milk Banking Association of North America (HMBANA) sets thorough guidelines for safe milk collection and use in North America. As of 2014, North America had 16 milk banks. As of 2013, they collected approximately 3,000,000 oz.

Singapore:

On Thursday, August 17, 2017, Singapore opened a three-year trial donor breast milk bank. It is a partnership between Temasek Foundation Cares and KK Women's and Children's Hospital (KKH). The milk bank, which will collect, screen, process, and store breast milk from donor mothers, has been allocated S$1.37 million (US$1 million) by the foundation.

Europe:

As of November 2018, there were 223 human milk banks operating in 28 nations across Europe, with 14 more planned. At the moment, Turkey has no milk banks, whereas Italy has the most with 37 milk banks.

Australia:

Australia had at least six human milk banks running as of 2020:

Red Cross Lifeblood

PREM bank in Australia (based at King Edward Memorial Hospital, WA and also supplying Princess Margaret Hospital)

Neonatal Intensive Care Unit (NICU) at Royal Prince Alfred (RPA) Hospital (NSW)

Mothers Milk Bank Pty Ltd, a private nonprofit that was formerly based on the Gold Coast but is now based in Tweed Heads, New South Wales, supplies some newborns in the neighbourhood as well as the Brisbane Mater Children's Hospital.

Hospital Mercy Breast Milk Bank (commenced 2011 at Mercy Hospital for Women, Heidelberg VIC)

Milk bank at Royal Brisbane and Women's Hospital (commenced November 2012 at the RBWH Grantley Stable Neonatal Unit)

A mother's own milk is considered the best nutritional supply for optimum baby health, with human milk serving as the biological norm for infant nutrition. WHO and UNICEF suggest donor human milk as the best substitute for a mother's own milk when it is not available for infants with low birth weights. Human milk banks are becoming more and more popular around the world as a result of growing awareness of the advantages of donor human milk and the demand for it.

Human milk from donors is readily available via human milk banks, could encourage mothers to utilise donor milk as a convenience product instead of supporting breastfeeding and providing their own milk. Supporting mothers in giving their newborns their own milk should always take priority in clinical settings. It's crucial to make sure that resources intended to assist breastfeeding aren't used instead to set up or operate human milk banks.

Building on the critical gaps that have been identified, it will be necessary to build a focused research agenda that will enable us to quickly generate the data needed to create solid global guidelines on the procedures related to human milk banking and the proper use of donor human milk. Also, there is an urgent need to construct milk banks all over the country, especially in the large neonatal units of all hospitals, given the high proportion of preterm deliveries in the nation and the level of malnutrition that results in such babies' postnatal growth after birth.