Maintaining human milk bank services throughout the COVID-19 pandemic: A global response.

If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID-19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open-ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic-related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context-dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies.

Comparison of lipid and calorie loss from donor human milk among 3 methods of simulated gavage feeding: one-hour, 2-hour, and intermittent gravity feedings.

PURPOSE: The objective of this study was to compare the differences in lipid loss from 24 samples of banked donor human milk (DHM) among 3 feeding methods: DHM given by syringe pump over 1 hour, 2 hours, and by bolus/gravity gavage. DESIGN: Comparative, descriptive. There were no human subjects. METHODS: Twenty-four samples of 8 oz of DHM were divided into four 60-mL aliquots. Timed feedings were given by Medfusion 2001 syringe pumps with syringes connected to narrow-lumened extension sets designed for enteral feedings and connected to standard silastic enteral feeding tubes. Gravity feedings were given using the identical syringes connected to the same silastic feeding tubes. All aliquots were analyzed with the York Dairy Analyzer. Univariate repeated-measures analyses of variance were used for the omnibus testing for overall differences between the feeding methods. Lipid content expressed as grams per deciliter at the end of each feeding method was compared with the prefed control samples using the Dunnett's test. The Tukey correction was used for other pairwise multiple comparisons. RESULTS: The univariate repeated-measures analysis of variance conducted to test for overall differences between feeding methods showed a significant difference between the methods (F = 58.57, df = 3, 69, P < .0001). Post hoc analysis using the Dunnett's approach revealed that there was a significant difference in fat content between the control sample and the 1-hour and 2-hours feeding methods (P < .0001), but we did not find any significant difference in fat content between the control and the gravity feeding methods (P = .3296). Pairwise comparison using the Tukey correction revealed a significant difference between both gravity and 1-hour feeding methods (P < .0001), and gravity and 2-hour feeding method (P < .0001). There was no significant difference in lipid content between the 1-hour and 2-hour feeding methods (P = .2729). CONCLUSIONS: Unlike gravity feedings, the timed feedings resulted in a statistically significant loss of fat as compared with their controls. These findings should raise questions about how those infants in the neonatal intensive care unit are routinely gavage fed.

Accuracy and Reliability of Infrared Analyzers for Measuring Human Milk Macronutrients in a Milk Bank Setting.

BACKGROUND: Infrared (IR) analysis is an emerging technology that may be a useful tool for milk banks to manage the nutrient variability in donor human milk. OBJECTIVE: To evaluate the accuracy, reliability, and comparability of commercial infrared analyzers for measuring human milk macronutrients in a milk bank setting. METHODS: Three nonprofit milk banks received blinded test kits of human milk that had been assessed using reference methods. Four infrared instruments were used to measure macronutrients as follows: 1 filtered mid-IR, 2 Fourier-transformed full-spectra mid-IR, and 1 near-IR. Twenty-five unique samples were read concurrently for the accuracy arm. An identical sample was read daily for 1 mo for the reliability arm. RESULTS: Values for R 2 describing relationships with reference methods for total fat, crude protein, and lactose, were as follows: filtered mid-IR, 0.98, 0.94, and 0.48; Fourier-transformed full-spectra mid-IR, 0.97, 0.93, and 0.36 for instrument 1 and 0.98, 0.98, and 0.31 for instrument 2; and near-IR 0.93, 0.93, and 0.12. There was no significant difference between instruments for crude protein and total fat measurements. There were significant differences in carbohydrate measurements between instruments. For 1 mo of daily measurements in the reliability arm, CVs for filtered mid-IR were ≤4.6%, for Fourier-transformed full spectra mid-IR were ≤1.7%, and for near-IR were ≤5.1%. CONCLUSIONS: Infrared analysis is an accurate and reliable method for measuring crude protein and total fat in a milk bank setting. Carbohydrate measurements are less accurate and are significantly different between instruments, which will likely lead to differences in derived calorie values.

Ebola Virus and Marburg Virus in Human Milk Are Inactivated by Holder Pasteurization.

BACKGROUND: Potential donors of human milk are screened for Ebola virus (EBOV) using standard questions, but testing for EBOV and Marburg virus (MARV) is not part of routine serological testing performed by milk banks. Research aim: This study tested the hypothesis that EBOV would be inactivated in donor human milk (DHM) by standard pasteurization techniques (Holder) used in all North American nonprofit milk banks. METHODS: Milk samples were obtained from a nonprofit milk bank. They were inoculated with EBOV (Zaire strain) and MARV (Angola strain) and processed by standard Holder pasteurization technique. Plaque assays for EBOV and MARV were performed to detect the presence of virus after pasteurization. RESULTS: Neither EBOV nor MARV was detectable by viral plaque assay in DHM or culture media samples, which were pasteurized by the Holder process. CONCLUSION: EBOV and MARV are safely inactivated in human milk by standard Holder pasteurization technique. Screening for EBOV or MARV beyond questionnaire and self-deferral is not needed to ensure safety of DHM for high-risk infants.

Pasteurized Donor Human Milk Maintains Microbiological Purity for 4 Days at 4°C.

BACKGROUND: Most protective components in human milk are stable during prolonged storage at 4ºC; however, pasteurization reduces some microbicidal activities responsible for suppressing microbial growth and protecting against infection. Donor milk used by neonatal intensive care units (NICUs) is frozen pasteurized donor human milk (PDHM) defrosted and stored at 4ºC. Current Human Milk Banking Association of North America (HMBANA) Best Practice guidelines recommend that milk be discarded 24 hours after being thawed, but experimental data on the duration of microbiological purity in thawed PDHM are sparse. OBJECTIVE: This study evaluates microbiological purity of thawed PDHM during prolonged storage at 4ºC. METHODS: A total of 42 independent, randomly selected PDHM samples were thawed at 4ºC. As is typical in NICUs, each bottle was opened at 3-hour intervals and 3 mL was withdrawn with a sterile syringe and transferred into a sterile tube. The 3 mL samples removed at 0, 24, 48, 72, 96 hours, and 9 days were tested for the presence of any microorganisms by a clinical laboratory that routinely screens PDHM for microbes. RESULTS: No evidence of microbial growth was observed in cultured samples taken at 0 to 9 days after thawing of the milk samples. CONCLUSION: There was no evidence of microbes in PDHM as dispensed by HMBANA milk banks when defrosted and stored at 4ºC for up to 9 days. Extended storage of PDHM in the NICU could reduce waste of donor milk, thereby increasing availability of human milk to vulnerable neonatal patients.