RESUMO
BACKGROUND: Globally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle-income countries. In the absence of mother's milk, the World Health Organization recommends using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal disorder. The use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality, yet very little is known about the nutritional composition of DHM. Additional knowledge gaps include how DHM composition is influenced by milk banking practices, and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers. METHODS: We designed a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings that will examine and compare a broad range of nutrients and bioactive factors in human milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM. We will then simulate the random pooling of 2 to 10 donors to evaluate the impact of pooling as a potential strategy for milk banks to manage nutrient variability in DHM. Finally, we will evaluate whether commercially available fortifiers meet nutrient recommendations when used with DHM. DISCUSSION: We expect that results from this study will improve nutritional care globally for the growing number of preterm infants who receive donor human milk.
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Bancos de Leite Humano , Leite Humano , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Nutrientes , Apoio Nutricional , Estudos Multicêntricos como AssuntoRESUMO
Background: Donor human milk (DHM) is the recommended feeding for preterm infants when mother's own milk is unavailable or insufficient. DHM macronutrient's variability may have significant implications on preterm growth. Different pooling strategies could be used to improve the macronutrient content, facilitating the achievement of nutritional requirements of preterm. Objective: The aim was to compare the impact of random pooling (RP) and target pooling (TP) strategies on the macronutrient content of DHM and to identify which RP practice allows the achievement of a macronutrient composition as similar as possible to that achievable with TP. Methods: The macronutrient content of 1,169 single-donor pools was analyzed, and a TP strategy combining 2,3,4, or 5 single-donor pools was adopted. On the bases of single-donor pools' analyses, a simulation of 10,000 randomly selected pools for each configuration of donor considered and for different milk volume proportions was performed. Results: Regardless of the type of strategy and milk volume, as the number of donor per pool increases, the percentage of pools with a macronutrient content equal or higher than the reference values for human milk increases. Conclusion: When a TP strategy is not feasible, a RP strategy combining at least five donors should be performed to obtain a better macronutrient content of DHM.
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Bancos de Leite Humano , Leite Humano , Lactente , Feminino , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Aleitamento Materno , Nutrientes , Doadores de TecidosRESUMO
BACKGROUND: High-temperature short-time (HTST) pasteurization (72-75 °C, 15 s) is an alternative treatment to traditional Holder pasteurization (HoP) (62ºC, 30 min) for donor milk. HTST pasteurization guarantees the milk's microbiological safety and retains more of its biologically and nutritionally active compounds, but the cost of implementing this technology for a human milk bank is unknown. METHODS: A cost-minimization study was carried out on the facilities of a regional human milk bank in a public hospital. Total production costs (fixed plus variables) were quantified using HTST pasteurization and HoP in three hypothetical scenarios: (1) costs of the first 10 L of pasteurized milk in a newly opened milk bank; (2) costs of the first 10 L of pasteurized milk in an active milk bank; and (3) costs using the maximum production capacity of both technologies in the first two years of operation. The following costs were analyzed: health care professionals, equipment and software, external services, and consumables. RESULTS: In scenario 1, the total production costs were 228,097.00 for the HTST method versus 154,064.00 for the HoP method. In scenario 2, these costs were similar ( 6,594.00 for HTST pasteurization versus 5,912.00 for HoP). The cost of healthcare professionals was reduced by more than half when pasteurization was carried out by the HTST method versus the Holder method ( 84.00 and 191.00, respectively). In scenario 3, the unit cost of milk pasteurized by the HTST method decreased from the first to the second year by 43.5%, while for the HoP method, it decreased by 30%. CONCLUSIONS: HTST pasteurization requires a high initial investment in equipment; however, it provides a significant minimization of production costs in the long term, pasteurizes large quantities of donor milk per working day and achieves a more efficient management of the time of the health care professionals in charge of the bank's operation compared to HoP.
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Bancos de Leite Humano , Leite Humano , Feminino , Humanos , Pasteurização/métodos , Aleitamento Materno , Doadores de TecidosRESUMO
Introduction: Pasteurized donor human milk provides nutrition and bioactive factors for infant growth and health when a mother's own milk is not available. Bacteriological testing is recommended for each pasteurized batch of donor milk before distribution to ensure that the milk is safe for use. Charm Peel Plates (CPPs) are a simplified, easy-to-use culture method for detecting microorganisms in milk and milk products. This study investigates the feasibility of using CPPs as an alternative test for current standard postpasteurization screening by human milk banks (HMBs), particularly those in resource-limited settings. Aim: The aim of this study was to evaluate the feasibility of using the CPP versus the 5% horse blood agar (HBA) plate (standard South African National Health Laboratory Service method) for detecting bacterial growth in pasteurized human milk samples. Methods: For each of the 50 pasteurized donor milk samples, 100-µL aliquots were cultured on routine HBA and 1 mL on CPPs for the total bacterial colony count. Any positive growth was identified using VITEK® 2 (bioMérieux). To demonstrate the ability of CPPs to support bacterial growth, four spiked samples were tested. Results: Concurrent negative test results were reported for 49/50 (98%) samples with only one positive test with HBA. Conclusions and Recommendations: The CPP is equivalent to HBA for detection of bacterial growth. Additional advantages of CPPs are ease of use and cost-effectiveness. The CPP is therefore recommended as a point-of-care, bacteriological screening method for donor human milk by HMBs, particularly those in resource-limited settings.
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Infertilidade , Bancos de Leite Humano , Lactente , Feminino , Humanos , Leite Humano/microbiologia , Aleitamento Materno , Pasteurização/métodosRESUMO
In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.
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Bancos de Leite Humano , Leite Humano , Lactente , Feminino , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Aleitamento Materno , Europa (Continente)RESUMO
La leche materna donada es un recurso de alto valor que puede ser utilizado para la alimentación de neonatos hospitalizados y a término, por tanto, garantizar su inocuidad es imperativo. Esta revisión de literatura reúne los principales peligros de naturaleza física, química y microbiológica identificados en leche materna, con la intención de proveer una referencia que los consolide de tal forma que la información pueda ser utilizada por bancos de leche humana, gobiernos y agencias regulatorias para establecer mecanismos para su prevención y control. Se realizó una revisión de literatura entre agosto del 2021 y octubre del 2022, utilizando buscadores y descriptores específicos para peligros de transmisión alimentaria en leche materna. Se incluyeron estudios publicados en español o en inglés. Se identificaron 31 agentes biológicos patógenos incluyendo bacterias, virus y parásitos. Como peligros químicos se reportaron medicamentos, drogas, cafeína, infusiones herbales, micotoxinas, alérgenos, especias, suplementos nutricionales, contaminantes ambientales y desinfectantes. Se alerta sobre la presencia potencial de plástico y vidrio de tamaño menor a 7 mm proveniente del ambiente de extracción y recipientes. La presencia de peligros microbiológicos y químicos en leche materna puede darse por transmisión vertical, temperaturas inadecuadas durante el almacenamiento y contaminación en el proceso. La presencia de peligros físicos se relaciona con la manipulación de los implementos en etapas posteriores a la extracción. Se requiere prestar atención a los hábitos de la madre para prevenir peligros químicos, así como más investigación relacionada con micotoxinas en leche materna(AU)
Donated breast milk is a highvalue resource which can be used to feed hospitalized neonates and full-term infants, therefore, ensuring its safety is imperative. This literature review presents the main hazards of physical, chemical and microbiological nature identified in human milk, with the intention of providing a reference that consolidates the reported hazards reported, so the information can be used by human milk banks, governments and regulatory agencies to establish prevention and control mechanisms. A literature review was carried out between August 2021 and October 2022, using search engines and specific descriptors for foodborne hazards in breast milk. Studies published in Spanish and English were considered. 31 pathogenic biological agents including bacteria, viruses and parasites were identified. Medications, drugs, caffeine, herbal infusions, mycotoxins, allergens, spices, nutritional supplements, contaminants of environmental origin and disinfectants were reported as chemical hazards. No physical hazards were identified, however the potential presence of plastic and glass smaller than 7 mm from the extraction environment or containers is alerted. Presence of microbiological and chemical hazards can be due to vertical transmission, inadequate temperature of storing, contamination during extraction, packaging, and infant feeding. Whereas presence of physical hazards is related to implements handling after extraction. Attention to hygiene and habits of the mother to prevent chemical hazards and further research related to mycotoxins in human milk is required(AU)
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Humanos , Feminino , Fatores Biológicos , Higiene , Poluentes Ambientais , Leite Humano , Preparações Farmacêuticas , Bancos de Leite Humano , Suplementos Nutricionais , Inocuidade dos AlimentosRESUMO
BACKGROUND: It is well known that the best nutritional option for infants is human milk, and that when breastfeeding is not possible, human milk banks are a possible alternative. However, in the case of infants with fat transport disorder like chylothorax, defatting of human milk is mandatory. RESEARCH AIM: The aim of the study was to reduce milk fat content without reducing other nutrients, increasing oxidative stress, or introducing harmful microorganisms. METHODS: In this prospective, cross-sectional, observational study, we examined the influence of defatting and pasteurization of 50 donor samples on fat, macro- and micronutrients, as well as on oxidative stress markers. RESULTS: Low-temperature centrifugation proved to be very efficient in defatting, reducing the concentration of triglycerides by 85% and cholesterol by 50%. The macronutrients (proteins, albumin, and Immunoglobulin A) did not undergo significant changes due to defatting and pasteurization procedures, while iron decreased by 36%. However, as the majority of iron is retained, this result does not remarkably change the milk composition. Furthermore, oxidative stress markers and antioxidant levels were unchanged, and the milk result was microbiologically safe. CONCLUSIONS: Cold milk centrifugation proved to be an effective technique that allows the reduction of human milk lipids. The determination of triglycerides and cholesterol can be used as an indicator of skimming. This procedure is not accompanied by substantial modifications of other components present in the milk.
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Bancos de Leite Humano , Leite Humano , Lactente , Feminino , Humanos , Pasteurização/métodos , Estudos Transversais , Estudos Prospectivos , Aleitamento Materno , Nutrientes/análise , Triglicerídeos , Estresse OxidativoRESUMO
Background: Donor milk is a good alternative for premature babies whose mothers cannot breastfeed. To reduce the risk of milk contamination, donors have to follow some hygiene instructions, including disinfecting their breast pump (BP). This study aims to investigate the efficacy of BP cleaning and disinfection methods. Methods: Contamination of BP parts was performed by passing milk inoculated with Bacillus cereus, Staphylococcus aureus, or Escherichia coli, through BPs. Devices were then rinsed with cold water or cleaned with hot soapy water. Disinfection was achieved using either a microwave or by immersing BP parts in boiling water. After treatment, residual bacteria were recovered by passing sterile phosphate buffer saline (PBS) through BPs before being inoculated on plates and performing bacterial counts. Method efficiency was assessed by comparing BP residual bioburden to results obtained from BPs that have not undergone cleaning or disinfection treatment (controls). Results: Rinsing BP parts with cold water leads to a diminution of residual bacteria in PBS recovered from device. This decrease is even more effective when hot soapy water is used. There is a slight persistence of all bacteria if disinfection of BPs is performed by using a microwave. This persistence reached up to 3.58 colony-forming unit/mL of sporulating B. cereus in PBS eluted from the pump parts. The use of boiling water, with or without cleaning step, removes bacteria to a level such that no residual contamination was observed. Conclusions: Cleaning BP parts in hot soapy water followed by a disinfection in boiling water ensures a completed decontamination of the BP. These results give evidences for instructions to milk bank donors for whom reducing risks of infections to minimal level is essential.
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Aleitamento Materno , Bancos de Leite Humano , Feminino , Humanos , Desinfecção/métodos , Bactérias , Contaminação de EquipamentosRESUMO
Estudo realizado pelo Banco de Leite Humano do Hospital Central de Maputo, em Moçambique. Foi utilizado o método retrospectivo e descritivo no período de janeiro de 2019 a dezembro de 2019 (pré-COVID-19) e janeiro de 2020 a dezembro de 2020 (período pandêmico da COVID-19) com as mulheres lactantes que doaram o leite materno vinculado a coleta domiciliar como estratégia para aumentar as doações de leite humano. O estudo mostrou que a coleta domiciliar de leite humano é uma estratégia eficaz que poderia aumentar o volume de leite doado em seis mais.
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Bancos de Leite Humano , Aleitamento Materno , Promoção da Saúde , COVID-19 , MoçambiqueRESUMO
No dia período de 07 a 11 de novembro de 2022, foi realizada a missão de cooperação técnica em Bancos de leite Humano em El Salvador, para a Implementação do Programa de Certificação da Qualidade da Rede Global de Bancos de Leite Humano em El Salvador.
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Cooperação Internacional , Cooperação Técnica , Bancos de Leite Humano , El Salvador , BrasilRESUMO
A Rede Brasileira de Bancos de Leite Humano (rBLH) já deu início à organização das celebrações do Dia Mundial da Doação de Leite Humano - 19 de maio, o edital com as normas do processo de escolha do slogan para mobilização social em favor da doação de leite humano 2023, já se encontra disponível.
Assuntos
Promoção da Saúde , Bancos de Leite Humano , Leite Humano , Aleitamento MaternoRESUMO
A sexta edição da rBLH em Dados já se encontra disponível com as informações do monitoramento anual de produção da Rede Brasileira de Bancos de Leite Humano. Informações relacionadas às atividades desenvolvidas no âmbito da Rede Global de Bancos de Leite Humano no fortalecimento das estratégias para promoção do aleitamento materno e consequentemente, do aumento das possíveis mães doadoras, associado ao acesso ao leite processado conforme as normativas de qualidade e higiene é uma estratégia primordial para que finalmente a mortalidade neonatal precoce possa ser reduzida.
Assuntos
Bancos de Leite Humano/estatística & dados numéricos , Leite Humano , Aleitamento MaternoRESUMO
Background: Donor milk banks have strict donor screening criteria to ensure that donor milk is safe for premature or hospitalized babies. Yet little evidence is available to understand how potential donors, who are often breastfeeding their own infants, experience being ineligible ("deferred") to donate their milk to a milk bank. Materials and Methods: Interviews were conducted with 10 mothers who were permanently or temporarily deferred from donating to a large, not-for-profit milk bank in Australia. Interviews focused on becoming a donor and being deferred, meanings of deferral, impact of deferral on feeding own infant, and improving the deferral process. Results: Thematic analysis of interviews identified nine themes: (1) donation as a solution to wasting milk; (2) eligibility questions were acceptable and understandable; (3) more information early on allows self-deferral; (4) deferral is not always clear; (5) deferral is disappointing but does not prevent future donation; (6) deferral did not prevent feeding own infant; (7) early information enables preparation for donation; (8) slow communication disrupts perfect timing to donate; and (9) alternatives to wasting milk. Conclusions: Milk banks have a duty of care to both milk recipients and donors. While mothers who want to donate milk are disappointed by deferrals, clear communication protects their breastfeeding relationships with their own infants. Milk banks can improve their screening processes by providing information up-front and ensuring timely contact with mothers. Mothers can then make informed decisions about donating and not feel as if their milk and resources are "wasted."
Assuntos
Bancos de Leite Humano , Feminino , Lactente , Humanos , Animais , Aleitamento Materno , Leite , Mães , Doadores de TecidosRESUMO
Background: Microbiological quality is one of the key safety standards in human milk bank (HMB) operations. We describe the profiles of bacteria in donor human milk (DHM) before and after the pasteurization of samples collected from breastfeeding women in the hospital and from the community in the first HMB in Vietnam. Methods: Data were collected between February 2017 and January 2022 from an online HMB monitoring system. First, DHM samples were cultured, and the number of colony-forming units (CFU) were counted before (n = 708) and after pasteurization (n = 1146). The gram-staining method combined with the Vitek 2 Compact system were used to identify types of organisms at the Da Nang Hospital for Women and Children's Laboratory. Passing criteria for DHM included pre-pasteurization samples had a total colony count <105 CFU/mL and post-pasteurization was <10 CFU/mL. Results: During five years of operation, Da Nang HMB had 491 donors (48.7% were hospital and the rest community donors) who donated an average amount of 14.2 L over 45 days. Of this DHM volume, 84.9% of donor samples passed the pre- and post-pasteurization microbiological tests. DHM from community donors had a higher pass rate (87.8%) compared to that from hospital donors (79.5%). Before pasteurization, 15.4% of DHM samples had a bacteria count <103 CFU/mL, 63.0% had 103-<105 CFU/mL, and 21.6% had ≥105 CFU/mL. Most of the unpasteurized DHM samples (93.0%) had microorganism growth: with one organism (16.4%), two (33.9%), three or more (43.6%). After pasteurization, 17.9% samples had a bacteria count of 1−9 CFU/mL and 7.2% had ≥10 CFU/mL. DHM samples from community donors had a lower bacterial count and number of organisms than those from hospital donors both before and after pasteurization. The highest microorganisms from unpasteurized DHM samples were Staphylococcus epidermidis (74.2%), Acinetobacter sp. (52.1%), gram-positive bacillus (51.7%), Staphylococcus coagulase-negative (15.8%), and Staphylococcus aureus (10.5%). Common microorganisms from pasteurized DHM were gram-positive bacillus (21.0%), Staphylococcus epidermidis (3.9%), and Acinetobacter sp. (0.9%). Samples from the hospital tended to have a higher contamination with those microorganisms than those from community donors. Conclusions: The majority of DHM samples in Da Nang passed microbiological testing criteria. DHM from community donors had higher pass rates than hospital donors. Corrective actions are needed to improve HMB operations and hospital microbiological quality standards, as well as general improvements in water and sanitation.
Assuntos
Bancos de Leite Humano , Leite Humano , Criança , Gravidez , Feminino , Humanos , Animais , Leite Humano/microbiologia , Vietnã , Leite/microbiologia , Pasteurização/métodos , ColostroRESUMO
Objetivo: avaliar e comparar o conteúdo energético do leite humano cru e do leite humano processado de recém-nascidos pré-termo. Método: foram coletadas 68 amostras de leite por meio de ordenha manual e o processamento foi realizado no Banco de Leite Humano. O valor energético foi obtido por meio de cálculos matemáticos específicos. Resultados: foram analisadas 32 amostras de leite humano cru e 28 de leite humano pasteurizado. O percentual médio de creme foi de 3,84±1,3% e mediana de 4,5 % no leite pasteurizado, e no cru de 8,9±4,6% e 8,53%. A média e mediana do conteúdo energético do leite cru foi de 78,91±15,46 kcal/100 ml e 81,07 kcal/100 ml e no leite pasteurizado 65,18±9,67 kcal/ 100 ml e 61,8 kcal/100 ml. Conclusão: o leite humano cru possui percentual de gordura e conteúdo energético maior do que o pasteurizado, mas este ainda é recomendado devido seus benefícios protetores.
Objective: to evaluate and compare the energy content of raw human milk and processed human milk from preterm newborns. Method: 68 milk samples were collected by hand milking and processing was carried out at the Human Milk Bank. The energy value was obtained through specific mathematical calculations. Results: 32 samples of raw human milk and 28 of pasteurized human milk were analyzed. The average percentage of cream was 3.84±1.3% and a median of 4.5% in pasteurized milk, and in raw milk, 8.9±4.6% and 8.53%. The mean and median energy content of raw milk was 78.91±15.46 kcal/100 ml and 81.07 kcal/100 ml and in pasteurized milk 65.18 ± 9.67 kcal/100 ml and 61.8 kcal/100 ml. Conclusion: raw human milk has a higher percentage of fat and energy content than pasteurized milk, but it is still recommended due to its protective benefits.
Objetivo: evaluar y comparar el contenido energético de la leche humana cruda y la leche humana procesada de recién nacidos prematuros. Método: Se recolectaron 68 muestras de leche por ordeño manual y el procesamiento se realizó en el Banco de Leche Humana. El valor energético se obtuvo mediante cálculos matemáticos específicos. Resultados: se analizaron 32 muestras de leche humana cruda y 28 de leche humana pasteurizada. El porcentaje medio de nata fue 3,84±1,3% y una mediana de 4,5% en leche pasteurizada, y en leche cruda 8,9±4,6% y 8,53%. El contenido energético medio y mediano de la leche cruda fue de 78,91±15,46 kcal/100 ml y 81,07 kcal/100 ml y de la leche pasteurizada de 65,18±9,67 kcal/100 ml y 61,8 kcal/100 ml. Conclusión: la leche humana cruda tiene un mayor porcentaje de contenido graso y energético que la leche pasteurizada, pero aun así es recomendada por sus beneficios protectores.
Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano/química , Valor Nutritivo , Bancos de Leite HumanoRESUMO
BACKGROUND: WHO recommends donor milk as the next best choice if Mothers' own milk (MOM) is unavailable. At our milk bank, during the COVID 19 pandemic, we observed a steep decline in the collection of donor milk, while Pasteurised Donor human milk (PDHM) demand increased. This called for active intervention. METHODS: We employed the quasi-experimental quality improvement initiative. During September 2020 (baseline period) the team members identified modifiable bottlenecks and suggested interventions (using WhatsApp to increase follow up, telehealth and digital tools) which were implemented in October 2020 and the impact was evaluated till March 2021. The SMART aim was "to meet the demand (estimated as 15,000 ml/month) of donor milk for adjoining 80-bedded NICU". Process measures were; daily amount of donor milk collected, pasteurized donor milk disbursed to NICU, number of donors and frequency of donations. The balancing measure was that the collection of donor milk should not undermine the provision of freshly expressed MOM for babies. RESULTS: Collection of donor milk increased by 180% from baseline during the Intervention phase. This was sustained throughout the sustenance phase (November 2020 and March 2021) with an average monthly collection of 16,500 ml. Strikingly, the increased follow-up of mothers with emphasis on MOM decreased the NICU's donor milk requirement from 13,300 ml (baseline) to 12,500 ml (intervention) to 8,300 ml (sustenance). Monitoring of daily MOM used in the NICU revealed a 32% surge from 20,000 ml (baseline) to 27,000 ml (intervention) sustained at 25,000 ml per month. CONCLUSION: By improving the provisions of human milk banks, near-exclusive human milk feeding can be ensured even during the pandemic time.
Assuntos
COVID-19 , Bancos de Leite Humano , Feminino , Humanos , Leite Humano , Pandemias , Aleitamento Materno , COVID-19/prevenção & controleRESUMO
BACKGROUND: Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. METHODS: We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 - December 2019) (n = 101) and during the pandemic (March 2020 - December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother's need for psychological support during NICU stay and the duration of psychological follow-up after discharge. RESULTS: In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. CONCLUSION: Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.
Assuntos
COVID-19 , Bancos de Leite Humano , Feminino , Humanos , Recém-Nascido , Aleitamento Materno , Leite Humano , Unidades de Terapia Intensiva Neonatal , Pandemias , Estudos Retrospectivos , Recém-Nascido Prematuro , COVID-19/epidemiologia , Recém-Nascido de muito Baixo Peso , Itália/epidemiologiaRESUMO
Objective: To learn about the experiences of women who are milk donors and users of thehuman milk bank, who are mothers of pre-term infants, low birth weight infants and sick newbornshospitalized in a neonatal intensive care unit (NICU). Method Descriptive, qualitative, micro ethnographic study following the method proposed by James Spradley, focused semi-structured interviews were conducted with 10 human milk donor/receiver mothers. Results: six categories wereestablished: human milk for humans, motivation and maintenance of human milk donation, recognition of Human Milk Banks (HMLB) as a suitable place for donation, donating human milk requires commitment and technique, feelings of women donors and recipients, barriers to donation,from these categories emerged the central category "Donating human milk saves lives" ConclusionsDonating and receiving human milk is an experience in which biological, cultural, emotional and political aspects are linked. Women demand social recognition of the work of Human Milk Banksin the promotion, protection, support of breastfeeding, nutrition and protection of premature and sick newborns in neonatal units. (AU)
Objetivo: conocer las experiencias de las mujeres donantes de leche y usuarias receptoras del banco de leche humana, que son madres de recién nacidos pre-término, recién nacidos debajo peso y recién nacidos enfermos hospitalizados en una unidad de cuidado intensivo neonatal(UCIN). Método Estudio descriptivo, de tipo cualitativo, micro etnográfico siguiendo el métodopropuesto por James Spradley, se realizaron entrevistas semiestructuradas focalizadas a 10 madresdonantes/receptoras de leche humana. Resultados: seis categorías fueron establecidas: leche de humanos para humanos, motivación y mantenimiento de la donación de leche humana, reconocer losBancos de Leche Humana (BLH) como un lugar idóneo para la donación, donar leche humana exigecompromiso y técnica, sentimientos de las mujeres donantes y receptoras, barreras para la donación,de estas categorías emergió la categoría central Donar leche humana salva vidas ConclusionesDonar y recibir leche humana es una experiencia en la cual se vinculan aspectos biológicos, culturales, emocionales y políticos. Las mujeres reclaman el reconocimiento social, a la labor de los Bancosde Leche Humana en la promoción, protección, apoyo a la lactancia materna, la nutrición y protección de los prematuros y recién nacidos enfermos en las unidades neonatales. (AU)
Objectivo: Conhecer as experiências de mulheres dadoras de leite e utilizadorasdo banco de leite humano, mães de bebés pré-termo, bebés de baixo peso ao nascer e recém-nascidos doentes hospitalizados numa unidade de cuidados intensivos neonatais(UCIN). Método Estudo descritivo, qualitativo, microecnográfico seguindo o método proposto por James Spradley, foram realizadas entrevistas semi-estruturadas com 10 mãesdoadoras/receptoras de leite humano. Resultados: foram estabelecidas seis categorias:leite humano para consumo humano, motivação e manutenção da doação de leite humano, reconhecimento dos Bancos de Leite Humano (HMLB) como local adequado paraa doação, a doação de leite humano requer empenho e técnica, sentimentos das mulheresdadoras e receptoras, obstáculos à doação, destas categorias surgiu a categoria central"Doar leite humano salva vidas" Conclusões Doar e receber leite humano é uma experiência em que os aspectos biológicos, culturais, emocionais e políticos estão ligados. As mulheres exigem o reconhecimento social do trabalho dos Bancos de Leite Humano na promoção, protecção, apoio à amamentação, nutrição e protecção de recém-nascidos prematuros e doentes em unidades neonatais. (AU)
Assuntos
Humanos , Feminino , Bancos de Leite Humano , Leite Humano , Aleitamento Materno/etnologia , Aleitamento Materno/psicologia , Lactação/etnologia , Lactação/psicologia , ColômbiaRESUMO
Donor human milk is the recommended alternative for feeding preterm or low birth weight infants when the mother's own milk is unavailable or not in sufficient quantity. Globally, the needs of vulnerable infants for donor human milk exceed the supply. This review aimed to identify the factors impacting the sustainability of human milk donation to milk banks. A systematic review of the literature was performed on eight databases to retrieve articles published until December 2021. The study protocol is available in PROSPERO (#CRD42021287087). Among the 6722 references identified, 10 studies (eight quantitative observational and two qualitative) met the eligibility criteria for a total of 7053 participants. Thirty factors influencing the sustainability of the donations to milk banks were identified and categorized as follows: (1) donation duration, (2) donors' infant features (e.g., gestational age, birth weight), (3) donors' features (e.g., socio-demographic characteristics, milk donation history), and (4) factors related to the milk bank and health care systems (awareness and support). The available evidence suggests that larger volumes of donated milk are associated with a longer duration of donation, as are early donation, previous milk donation, and donors with an infant of smaller weight and gestational age. Supporting and encouraging early donation and recruiting donors with infants of low birth weight and low gestational age could support longer donation times and greater volumes of milk donated. To identify efficient strategies and to draw appropriate recommendations to improve donor milk access, future studies should further explore the issues of the sustainability of human milk donation to milk banks.
Assuntos
Bancos de Leite Humano , Leite Humano , Recém-Nascido , Humanos , Feminino , Recém-Nascido de Baixo Peso , Idade Gestacional , Fatores de Tempo , Aleitamento MaternoRESUMO
BACKGROUND: To date, 40 Human Milk Banks (HMB) have been established in Italy; however, recent cost analysis data for operating an HMB in Italy are not available in the literature. METHODS: This study was a cross-sectional study performed at "Bambino Gesù" Children's Hospital in Rome, Italy in 2019. We assessed the one-year operational costs and, the per liter unit costs at our HMB. RESULTS: During the 2019 year we collected 771 l of human milk supplied by 128 donors. The total cost was 178,287.00 and the average cost was 231.00 per liter. 188,716.00 would have been spent had the maximum capacity for 904 l been reached. We found a significant difference ( 231.00 vs 209.00 per liter, p = 0.016) comparing the cost for collected liters in the year 2019 and the cost for the maximum capacity of the bank for that year of activity. Analyzing each cost item that determines the charge of donor human milk (DHM), the highest costs are the salaries of medical and paramedical staff, and then the costs related to transporting. If the HMB works at maximum capacity and manages a greater number of liters of milk, this can represent an important saving. Conversely, the price of consumables is modest (i.e., the price of a single-use kit for breast pumps was 0.22 per unit). CONCLUSION: The costs for a liter of DHM are quite high, but they must be related to the benefits, especially for preterm infants. Comparing the cost for collected liters in 2019 and the costs for the 2019 maximum capacity of the HMB, we calculated how much fixed costs of collection and distribution of DHM can be reduced, by increasing the volume of milk collected. To the best of our knowledge, this is the first complete cost analysis for an Italian Milk Bank. A thorough analysis could help to abate fixed costs and reduce the cost of a liter of DHM. The centralization of DHM can allow savings, rather than creating small HMBs scattered throughout the territory that would operate with lower milk volumes.
