Introduction
In recent years, donor human milk is considered a preferred nutrient substrate to feed babies for whom mothers' own milk is not available and also extremely premature neonates. Several clinical data validate the efficacy, cost-effectiveness, and safety of giving donor human milk to babies. Most countries such as North America and Southeast Asian countries like Vietnam have established human milk banks and have formulated exclusive criteria for human milk donor selection, the latest pasteurization techniques, and quality control measures to ensure safe human milk donation. Human milk sharing is one of the rapidly progressing infant feeding practices in the U.S. (the United States) where milk sharing helps parents by providing an alternative to infant-formula feeds as well as pasteurized donor milk.
What Are Human Milk Banks?
Human milk is the standard biological nutrition for neonates and infants where the mother’s own milk (MOM) provides all the essential nutrition for the optimal baby’s health. But in some situations, neonates and infants are unable to get breast milk from their own mothers. In such conditions donor human milk is identified as the best alternative.
Donor Human Milk - Refers to the milk that is expressed and donated by the lactating women, undergoes processing and pasteurization, followed by distribution to a recipient baby who is not the own child of the donor. Human milk banks (HMBs) play a vital role in collecting donated human milk and ensuring a safe and effective way of its use.
Donor Human Milk Bank - Also known as HMB is a nonprofit organization that constitutes processes and systems for screening breast milk donors, collecting human milk, screening, processing (pasteurizing), storing, and dispensing the donated milk to the recipient babies.
What Are the Benefits of Milk Banking?
Human milk banking establishes a friendly breastfeeding health system by facilitating access to the enormous benefits of breastmilk to babies who are in need of it. Some of the indications where human milk banking is proven beneficial are as follows -
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High-risk neonates such as pre-term babies.
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Low birthweight infants (birth weight less than 1500 g).
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Vulnerable infants with severe intestinal infections.
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Neonates in NICU (neonatal intensive care units).
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Infants with necrotizing enterocolitis.
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Lactation problems in mothers where sufficient breast milk is not produced.
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In cases of maternal illnesses (like breast cancer or tuberculosis), where breastfeeding is not recommended.
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Mothers who are under certain medications or therapies (chemotherapy) are advised not to breastfeed their babies.
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Babies who are allergic or intolerant to formula feed.
How Are Milk Donors Selected?
Milk banking guidelines and protocols are widely evidence-based and strictly standardized. Donor selection always follows the careful evaluation of the health history and complete medical screening of the potential donor. The inclusion criteria for human milk donors are as follows -
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Human milk donors should be in good health.
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They should not be under any medications or herbal treatments.
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They must be nursing an infant who is less than one year old.
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Lactating mothers who are having extra milk after breastfeeding their own babies.
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Lactating women who have experienced recent perinatal loss also donate milk to human milk banks.
Human Milk Donor Screening Standards
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Screening for human milk donors involves rigorous steps and includes verbal and written consent from the donors.
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Initial screening and recording consent is mostly done by verbal and written communication and is not limited to electronic means of communication.
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Milk banks maintain a confidential relationship with every milk donor by protecting their personal details.
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Milk Banks do periodic updates of donors’ health and medical status and also their lifestyle changes every two months throughout the donation period.
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Serological screening for HIV, human T-cell lymphoma virus, hepatitis B, hepatitis C, and syphilis are conducted in potential donors.
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Donors are made aware of situations during which donation is not allowed and are instructed to immediately report to the milk banks.
The following are the conditions when temporary deferral durations or permanent donor exclusions are instructed -
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Smoking and using tobacco products.
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Use of illegal psychoactive drugs.
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Risk of transmitting infectious proteins as in the case of Creutzfeldt-Jakob disease (CJD).
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Positive serological test results for HIV (human immunodeficiency virus), HTLV (human T-lymphotropic virus type 1), hepatitis B or C, or syphilis.
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Use of non-approved medications.
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Recent history of blood transfusions.
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Risk of blood-borne infections.
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Procedures involving needle pricking such as body piercing or tattooing.
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Donors who are on a vegetarian diet (vegan diet) and not supplemented with B12 vitamins.
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Donors who are at risk of contracting infections from a sexual partner.
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Recent travel history to endemic areas.
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Alcohol consumption.
How Is the Donor Human Milk Processed in Milk Banks?
Human milk is generally considered food and categorized as nutritional therapy. But, donor human milk is a biological substance produced from the human body and cannot be treated like other nutritional foods. It is considered a medical product (like blood donation) of human origin and undergoes processing from the clinical perspective (by World Health Organization). Regulatory committees such as the human milk banking association of North America (HMBANA) accredit the processing of human donor milk by milk banks started in the United States and Canada and also formulate international guidelines for human milk banking.
Human milk banks process human donor milk in the following ways -
Collection of Human Donor Milk
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Human donor milk is collected after complete health screening, serologic testing, and detailed information regarding collecting, storing, and transporting milk.
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Donated milk from various donors is pooled together to form a single batch of donor milk.
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Pooling is done using aseptic techniques under sterile conditions.
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Direct milk sharing considerably varies in the screening and collecting procedures.
Pasteurization
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Donor human milk is pasteurized by the Holder pasteurization method where the donor milk is heated at 62.5°C for 30 minutes.
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Bacteriological testing is conducted for each batch of pasteurized milk.
Storage and Distribution
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The majority of the donor milk is distributed to neonatal intensive care units.
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Frozen donor human milk is dispensed by following shipping guidelines formulated by the milk banks.
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Donor human milk is also distributed to out-patient recipients.
What Is Meant by Milk Sharing?
Milk sharing refers to the commercial‐free practice where the expressed breast milk from the lactating donor is directly provided to the recipient’s family to feed the neonate or infant. It also includes directly breastfeeding a recipient’s infant. Milk sharing is considered an alternative for parents for whom there is the unavailability of infant formula or Holder pasteurized banked donor milk.
Recent reports show that milk-sharing donors as well as recipients increasingly use online and offline social network platforms for these practices. Certain health regulatory organizations such as the Canadian Pediatric Society do not endorse the practice of sharing unprocessed human milk. The emergence of human milk sharing through the Internet has become problematic as direct milk sharing is associated with increased risks including the transmission of infections, unwanted exposure to medications or substances, and also microbial contamination related to storage and handling practices.
Conclusion
Globally, human milk banks are established in over 60 countries. These banks assess the safety of donor human milk, reduce the risk environments and ensure its safe distribution. On the other hand, the increased prevalence of direct milk-sharing methods holds potential risks related to screening and safety shortcomings.
