Methodologic considerations for improving and facilitating human milk research.

Over the past several decades, interest in using human milk as a biomonitoring matrix has increased. However, it is not always an easy matter for a new mother to provide a milk sample. In this article, guidance on facilitating collection of human milk is provided. This includes addressing the mother's ease in expressing a milk sample, and engaging with many audiences to reduce the likelihood of negatively impacting the already low breastfeeding rates in the United States. In addition, this article covers concepts regarding long-term storage and integrity of human milk samples to maximize the utility of those samples, and proposed methods for improving public access to the full spectrum of human milk biomonitoring data, with context to understand the information presented. The environmental chemicals and chemical classes for which robust analytical methods exist are enumerated, and a process for prioritizing the development of analytical methods for additional environmental chemicals is described.

Stories of success: the use of donor milk is increasing in North America.

Donor milk has been used to successfully treat a number of medical conditions in infants. This article highlights 3 such success stories describing the use of human milk in cases of velocardiofacial syndrome, very-low-birth weight, and failure to thrive. In 2002, more than 300 infants and young children and 15 adults received donor milk from 6 milk banks in the United States and I milk bank in Canada. Donor milk is often used to ensure optimal outcomes in full term or preterm infants until their own mother's milk volume is sufficient to meet their needs. However, human milk may be a lifesaving therapy for infants and young children with unusual medical conditions.

Human milk surveillance and research of environmental chemicals: concepts for consideration in interpreting and presenting study results.

This article describes issues related to the interpretation, presentation, and use of data from human milk surveillance and research studies. It is hoped that researchers conducting human milk studies in the future will consider these concepts when formulating study conclusions and presenting data. The key issues discussed are; (1) communication of information on human milk constituents to health care providers and the public; (2) complexities associated with assessing risks and benefits when comparing breast-feeding and formula-feeding; (3) use of human milk information for trends analysis and assessment of the efficacy of restrictions on use/release of chemicals in the environment; and (4) risk assessment and regulatory decision-making concepts regarding environmental chemicals in human milk. As researchers conduct surveillance and research involving human milk, it is of the utmost importance that the results of these studies are provided with information on risk and benefits that place the data in perspective, so that those involved in decision making regarding infant nutrition (e.g., expectant mothers, physicians, midwives, nurses, and lactation consultants) can appropriately interpret the research data.

Recipient prioritization and use of human milk in the hospital setting.

Donor human milk is used to treat and protect the health and development of preterm and term infants, and occasionally to treat illnesses in older children and adults. When donor human milk is in short supply nationally, decisions must be made with regard to the priority of recipients. This article reviews the importance of donor human milk in the hospital setting, describes the factors that are considered by the Human Milk Banking Association of North America when prioritizing eligible recipients if there is a shortage of donor milk, and discusses how human milk should be stored and handled in the hospital setting.