Survey of Italian human milk banks

Donor human milk programs in German, Austrian and Swiss neonatal units - findings from an international survey

Background

Donor human milk (DHM) has been recommended for premature infants if mothers’ own milk is not available. The aim of this study was to increase the knowledge about the utilization rate and handling of DHM among neonatal units in Germany, Austria und Switzerland.

Methods

Online survey of utilization rates and handling practices of DHM of all neonatal units within Germany, Austria and Switzerland providing care for premature infants less than 32 weeks of gestation.

Results

DHM utilization rate of 35% is low (50/142) within those 54% of units that responded to our survey (142/261). Only 26/50 units have DHM routinely integrated into their nutritional management protocols. Lacking access and difficult procurement were cited as the main obstacles for not using DHM. However, eight out of ten respondents currently not using DHM would like to introduce DHM in their unit if available. There were differences in most aspects of DHM handling including donor recruitment and screening, testing and treatment of milk microbiota and commencement of DHM utilization. Breastmilk feeding rates were increased in units utilizing DHM compared to those not utilizing DHM.

Conclusions

DHM is underutilized in most neonatal units caring for premature infants within participating countries. Lacking access to DHM represents the main barrier for utilizing DHM for premature infants.

The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Background. Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) to conduct meta-regression analyses by subgroups; (3) to describe geographical distribution of milk banks in the world. Methods. Papers included in the meta-analysis were updated as of June 2019. Relative risks were used as a measure of effect size. Random effect models were used to account for different sources of variation among studies. For milk banks, the data reviewed by the literature were integrated with the information collected from countries’ institutional sites and milk bank networks. Results. Thirty-two papers were included in meta-analysis: six randomized controlled trials (RCTs) and 26 observational studies (OS). The census has found 572 milk banks around in the world. Brazil has the most active milk banks. RCTs meta-analysis indicates a risk reduction of NEC using human milk respect to formula: Relative risk (RR) = 0.62 (0.42–0.93). Seven OS compared quantities lower than human milk or higher than the 50th quantile showing a risk reduction of NEC:RR = 0.51 (0.31–0.85); 3 OS that evaluated human milk versus mixed feeding showing that human milk has a protective role on the development of NEC:RR = 0.74 (0.63–0.91). Results of subgroups analysis show that the risk reduction is statistically significant only for studies in which premature infants are given both their own and donated breastmilk. Conclusions. The possibility of preserving human milk and promoting donations guarantees an improvement in the health of newborns.

Quality management in Human Milk Banks: a scope review

ABSTRACT Objectives: to identify the main quality management interventions used by professionals working at Human Milk Banks. Methods: a scope review conducted at PubMed, VHL, Scopus, SciELO, CAPES thesis and Google Scholar databases. Primary studies were included that address quality improvement strategies to improve Milk Bank processes in Portuguese, English and Spanish. Results: search totaled 192 scientific studies, 17 of which met the objective of the study and inclusion criteria. The main quality management interventions used in the Human Milk Bank addressed tools for continuous improvement. Six were aimed at improving processes, one to prevent errors and failures and two to achieve continuous monitoring. Final Considerations: the tools used by professionals working in Human Milk Banks have demonstrated effectiveness in managing the quality of services.

Perceptions on donated human milk and human milk banking in Nairobi, Kenya

Donor human milk (DHM) is recomended as the best alternative when use of mothers' own milk is not a feasible option. Kenya has not yet established human milk banks (HMBs) for provision of safe DHM, which is free from any physical, chemical, microbiological contaminants or pathogens. This study aimed to establish the perceptions on donating and using DHM, and establishing HMBs in Kenya. Qualitative data were collected through 17 focus group discussions, 29 key informant interviews, and 25 in‐depth interviews, with women of childbearing age, community members, health workers, and policy makers. Quantitative interviews were conducted with 868 mothers of children younger than 3 years. Descriptive analysis of quantitative data was performed in STATA software, whereas qualitative interviews were coded using NVIVO and analysed thematically. Majority of them had a positive attitude towards donating breast milk to a HMB (80%) and feeding children on DHM (87%). At a personal level, participants were more willing to donate their milk to HMBs (78%) than using DHM for their own children (59%). The main concerns on donation and use of DHM were personal dislikes, fear of transmission of diseases including HIV, and hygiene concerns. Ensuring safety of DHM was considered important in enhancing acceptability of DHM and successful establishment of the HMBs. When establishing HMBs, Kenya must take into consideration communication strategies to address the main concerns raised regarding the quality and safety of the DHM. The findings will contribute to the development of HMB guidelines in Kenya and other African contexts.

Anti-Cytomegalovirus Activity in Human Milk and Colostrum From Mothers of Preterm Infants

OBJECTIVES

This study aimed to investigate the anti-human cytomegalovirus (CMV) activity of milk from seropositive and seronegative mothers of preterm infants and to analyze its changes throughout the different stages of lactation and after Holder pasteurization, a procedure adopted by donor human milk banks.

METHODS

Eighteen mothers of preterm infants were enrolled in the study. Colostrum, transitional milk, and mature milk samples were collected and tested for anti-CMV activity. Depletion of immunoglobulins A from milk samples was carried out by jacalin resin. Pools of milk samples were pasteurized according to Holder technique.

RESULTS

All samples were endowed with anti-CMV activity, although to a different extent. In CMV IgG-positive mothers, colostra were significantly more active than the transitional milk and mature milk samples. Moreover, they were more potent than colostra from seronegative mothers. Immunoglobulins A depletion in colostra from IgG-positive mothers resulted in a partial loss of anti-CMV activity. Holder pasteurization significantly reduced the antiviral activity.

CONCLUSIONS

Human milk is endowed with anti-CMV activity and its potency may vary depending on the stage of lactation and the serological status of the mother. This biological property could partially neutralize CMV particles excreted in the milk of CMV IgG-positive mothers thus reducing the risk of transmitting infectious viruses to the infant.

Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial

Background

Human milk (HM) is the best feeding for premature infants. When own mother’s milk (OMM) is insufficient or unavailable, pasteurized donor human milk (PDHM) and preterm formula (PF) are the alternative nutritional sources, but the benefits of donor milk over formula are not defined. This study aimed to assess whether, in the absence of OMM, the PF could guarantee a feeding tolerance not inferior to that seen with the use of PDHM during the first two weeks of life of very preterm infants.

Methods

Infants with gestational age (GA) of ≤32 weeks who started enteral feeding within the first 7 days of life were randomized to receive PDHM or PF as a supplement to the OMM insufficient or unavailable. The primary outcome was the day of life when full enteral feeding (FEF) of 150 mL/Kg/d was achieved.

Results

Seventy infants were randomized, 35 in the PF group (GA 30.2 ± 1.7 weeks; BW 1342 ± 275 g), 35 in the PDHM group (GA 30 ± 1.9 weeks; BW 1365 ± 332 g). The time to achieve FEF was the same for infants fed with PF and for infants fed with PDHM (12.3 ± 7.0 days vs 12.8 ± 6.5).

Conclusions

This trial shows that PF could be a valid alternative for the early feeding of very preterm infants when OMM is insufficient or unavailable.

Trial registration

UMIN000013922. Date of formal registration: December 31, 2014.

HUMAN MILK BANK: CHALLENGES AND VISIBILITY FOR NURSING

ABSTRACT Objective: analyze the implementation process of the human milk bank of a university hospital in the state of Espírito Santo and discuss the implications of this deployment to the regional nursing practice. Method: in this historical and social search the primary sources were interviews conducted with eight nurses, and documents from the nursing section. The thematic content analysis and the theoretical framework of Pierre Bourdieu allowed mediation of the objective and subjective dimensions of the social world. Results: it was evidenced that the milk bank was designed in 1993 and implemented in 1994 by three nurses and a doctor. In its historical path, the human milk bank had the participation of nurses involved in knowledge-power relations marked by symbolic violence and resistance to the hegemonic medical power of the time. Conclusion: it was concluded that the implementation of a human milk bank did not happen as anticipated by the public policy of the time, which was the result of a complex power game involving health professionals and the institution itself.