A Tendência dos Serviços prestados pelos Bancos de Leite Humano entre 2010 e 2019 no Brasil

De acordo com o artigo Carrijo et. al (2022) rotineiramente, as nutrizes recorrem aos profissionais do Banco de Leite Humano para orientação sobre o manejo correto da amamentação (AM), para aprender ou corrigir a técnica, evitar complicações e possibilitar o estabelecimento e manutenção da lactação. Aconselhamento individual ou apoio em grupo, apoio imediato ao aleitamento após o parto e manejo da lactação foram intervenções que aumentaram o aleitamento materno exclusivo (AME) em 49% e o AM em 66%.

Mothers Who Engage in Long-Term Informal Milk Sharing.

Human milk has repeatedly been shown to be the best form of infant nutrition. Many reasons may prevent a family from providing human milk to their child, leaving them to seek other options. One alternative is informal milk sharing, where individuals and families find donor milk through online communities. We present perspectives from three mothers who used informal milk sharing for at least 6 months. Common themes identified are sadness, guilt, and stigmatization of informal milk sharing. Implications for practice include providing families and practitioners with resources for learning about informal milk sharing and navigating the community safely.

Implementation of the Reimbursement Cost of Human-Milk-Based Neonatal Therapy in Polish Health Care Service : Practical and Ethical Background.

BACKGROUND: A human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns. RESEARCH AIM: The study aims were to restructure the reimbursement rates to hospitals in Poland for infants' tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother's milk and evaluate the results of the financing change during the first year of implementation (2018). METHODS: Financial data from hospitals were collected (2015-2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants' tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services. RESULTS: More than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country. CONCLUSIONS: Based on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother's milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.

Milking the System: A Case Study of Donor Milk for a Child in Foster Care.

INTRODUCTION: Use of pasteurized donor milk is recommended in many situations when own mother's milk is not available. One existing knowledge gap is access to donor milk for infants in government custody (foster care). MAIN ISSUE: The focus of this case study is an infant born at 41 weeks who was discharged from the hospital into foster care. The infant soon developed failure to thrive due to formula intolerance. MANAGEMENT: After trying multiple formulas, which included elemental formulas, and hospitalization, the infant began pasteurized donor milk. Within 24 hr, the infant began gaining weight. Medicaid denied two authorization requests for payment, and the state's Department of Human Services ultimately agreed to cover the discounted donor milk fees until the infant reached 1 year of age. CONCLUSION: This foster child suffered through months of failure to thrive and hospitalization before receiving human milk feedings. This care violated ethical principles of beneficence, autonomy, and justice. State officials should review their policies and regulations for providing human milk to children in their care and facilitate access to that milk when needed.

Milk donation after losing one's baby: Adopting a donor identity as a means of coping with loss.

This is a study of bereaved mothers' donation of human milk to nonprofit human milk banks following their baby's death. Whereas much has been written about the biological and medical aspects of milk donations in times of loss, much less attention has been given to the psychosocial aspects of this phenomenon. I build on research of motivations for philanthropic giving in times of crisis and loss, and focus on the role of donor identity for explaining bereaved mothers' milk donations. Through a content analysis of 80 bereaved donors' personal testimonials, I demonstrate the role of a donor identity as a transformative identity in these women's process of coping with their loss. Taking on a temporary milk donor identity helped the women in this study reconstruct their shattered identities as mothers and healthy females and served to enfranchise them as bereaved mothers.

Donor Milk Utilization for Healthy Infants: Experience at a Single Academic Center.

BACKGROUND: Banked donor milk (BDM) has historically been used as an alternative to formula for preterm infants. Recently, BDM has been endorsed by two national organizations for use in healthy infants. We sought to quantify utilization trends and characteristics of mothers and their healthy newborns who received BDM during their postpartum stay between 2013 and 2016 at a single academic medical center. MATERIALS AND METHODS: In this observational study, we used a clinical log to identify all infants who received BDM in the well-baby nursery between July 2013 and June 2016. From this log, we abstracted data on the numbers of babies who received BDM, the quantity of BDM provided, and indications for usage. We also collected clinical data from the medical records of a subset of corresponding mothers and infants. RESULTS: BDM utilization increased over time in healthy infants, with 0.04% of infants before July 2014 receiving BDM compared with 4.7% in July 2015 to June 2016. During the same periods, the number of bottles provided per infant also increased, from 0.6 bottles per infant to 4.6 bottles per infant. The most common indications for providing BDM were parent/caregiver request (19%) and excessive weight loss/dehydration (17%). CONCLUSION: At our center, the use of BDM for healthy infants increased substantially over the study period. More research is urgently needed to understand the repercussions of this practice on resource utilization as well as short- and long-term breastfeeding and health outcomes.

Prevalence and Trends in Donor Milk Use in the Well-Baby Nursery: A Survey of Northeast United States Birth Hospitals.

BACKGROUND AND OBJECTIVES: Pasteurized donor human milk ("donor milk") is an alternative to formula for supplementation of breastfed infants. We conducted a survey to determine (1) prevalence, trends, and hospital-level correlates of donor milk use for healthy newborns in the northeast United States and (2) clinician knowledge and opinions regarding this practice. METHODS: We conducted parallel surveys of clinicians (88% nurse and/or lactation consultant) at (1) all birth hospitals in Massachusetts (MA) and (2) all birth hospitals served by a northeast United States milk bank. We asked about hospital use of donor milk for newborns ≥35 weeks' gestation and receiving Level I care in well nursery, hospital-related factors we hypothesized would be associated with this practice, and clinician knowledge and opinions about donor milk use. RESULTS: 35/46 (76%) of MA birth hospitals and 51/69 (74%) of hospitals served by the milk bank responded; 71 unique hospitals were included. Twenty-nine percent of MA birth hospitals and 43% of hospitals served by the milk bank reported using donor milk for healthy newborns. Hospitals that used donor milk for healthy newborns had higher exclusive breastfeeding at hospital discharge than hospitals that did not (77% versus 56%, p = 0.02). Eighty-three percent of respondents agreed or strongly agreed that using donor milk is an effective way to increase the hospital's exclusive breastfeeding rate. CONCLUSIONS: Many northeast United States birth hospitals currently use donor milk for healthy newborns. This practice is associated with higher exclusive breastfeeding at hospital discharge. Relationships with breastfeeding after discharge and related outcomes are unknown.

Establishment, operation and development of a donor human milk bank.

Human milk is very valuable in premature infant nutrition. The collection, screening, processing and distribution of donor human milk are described in this report. These activities take place in the Donor Human Milk Bank (DHMB) of the Large Romagna Area (LRA) in Italy, the development of which is also described here. Over the years, the activities of this bank, which is located in Cesena Hospital, in the center of the LRA, have developed from an informal and domestic-level activity to become a multistep controlled process designed to prevent the possibility of disease transmission. This little food-supply industry, run by a multi-disciplinary team with strict rules and diverse responsibilities, complies with the Hazards Analysis and Critical Control Points (HACCP) system.

Donor human milk banking and the emergence of milk sharing.

Donor human milk has emerged as the preferred substrate to feed extremely preterm infants, when mother's own milk is unavailable. This article summarizes the clinical data demonstrating the safety, efficacy, and cost-effectiveness of feeding donor human milk to premature babies. It describes the current state of milk banking in North America, as well as other parts of the world, and the differing criteria for donor selection, current pasteurization techniques, and quality control measures. A risk assessment methodology is proposed, which would allow milk banks globally to assess the safety of their process and respond appropriately to differing risk environments.

The knowns and unknowns of human milk banking.

The PREM Bank has been providing pasteurised donor human milk (PDHM) to very preterm for the past 3 years. It is the first human milk bank (HMB) to operate in Australia in over 20 years. Our community has rapidly embraced the concept of human milk banking, with both donations and demand for PDHM exceeding expectations. Providing PDHM in 'exceptional circumstances' where a mothers' own milk is unavailable is supported by the WHO and UNICEF. We submit that neonatal intensive care is an exceptional circumstance. Although evidence supporting PDHM use from randomised control trial (RCT) is limited, the latest systematic reviews suggest a lower risk of necrotising enterocolitis with PDHM as opposed to artificial formula. Study design and ethical issues may limit future evidence from RCT. We therefore support the ongoing use of PDHM in neonatal care, where provided by an appropriately managed HMB. Internationally many HMBs operate unregulated, and this is also the case in Australia. To ensure safety the PREM Bank has committed to meet the appropriate standards recommended in the Code of Good Manufacturing Practices (Blood and Tissues) in Australia and models risk management during processing on Codex HACCP (Hazard Analysis Critical Control Point) requirements. There is scope to continually re-evaluate the screening of donors and quality standards recommended during HMB. This will be most effective if strong networks of HMBs are developed with regional reference laboratories to encourage compliance with safety guidelines. HMB networks will facilitate collection of evidence for refining HMB practice and improving outcomes for preterm and sick infants.

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.

Trends in donor milk banking in the United States.

Modern donor milk banking was conceived in the US in the early 1900s as a medicalized version of wet nursing. Over the course of the century the fortunes of donor milk banking have varied considerably. In the last 20 years donor milk banking has been negatively affected by the development of specialty formulas, safety issues related to viral transmission, and lack of clinical research. To survive, US milk banks have been receptive to clinical uses considered as "alternative medicine," and have cooperated with governmental agencies to develop standards for safety. A qualitative analysis of collected case histories of US donor milk recipients demonstrates that donor human milk banking can be critical to survival and the well-being of at-risk infants, children, and the occasional adult. By analyzing national data collected by survey method and examining the literature, the researcher compared German and US milk banks and distribution data. German milk banks use donor milk exclusively for premature infants and have less stringent operating standards, yet dispense volumes of milk greatly in excess of the US milk banks. While statistics are lacking for the total recipient population in the US, a projected analysis (based on German consumption) of the potential volume that could be dispensed in the US is presented, indicating that the population in need of this crucial public health service is currently under-served in the US.

A year of remarkable growth for donor milk banking in North America.

In 1999, approximately 322,700 ounces of milk were processed and distributed by the 7 member banks of the Human Milk Banking Association of North America. One new bank opened, and 2 medical centers in the United States are considering opening donor banks. The majority of the recipients were preterm and sick infants, but milk was also ordered for older babies and for children with a variety of medical needs, including metabolic disorders, severe food allergies or feeding intolerance, short gut syndrome secondary to necrotizing enterocolitis, growth failure on formula, and intractable rotavirus, and during chemotherapy for cancer. Donor milk was also ordered for adopted infants who did not have medical problems and for some adult cancer patients. Member banks serum screened 770 potential donors. One donor was excluded for a positive Hepatitis C test, and 3 were excluded for positive HTLV results. Further confirmatory tests were negative for these 4 potential donors.