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.

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.

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.

Estudio de calidad de la pasteurización Holder de leche materna donada en una unidad de nutrición personalizada neonatal / Quality study of Holder pasteurization of donor human milk in a neonatal personalized nutrition unit

Objetivo: La pasteurización Holder es la técnica utilizada más comúnmente en bancos de leche materna para minimizar el riesgo de transmisión de agentes infecciosos. Se han descrito distintos sistemas de pasteurización, que generalmente emplean agua o aire caliente como fuentes de calor. En el presente estudio, se analizó la calidad de la pasteurización realizada con una nueva pasteurizadora automatizada en seco, en una unidad de nutrición personalizada neonatal que procesa leche materna donada de madres de lactantes nacidos a distintas edades gestacionales y de diferentes edades postnatales.Material y método: Se analizó la temperatura durante las distintas fases de la pasteurización con ocho sondas externas distribuidas uniformemente por toda la pasteurizadora. Se aplicaron los criterios óptimos recomendados por la Asociación Europea de Bancos de Leche (EMBA) para monitorizar la calidad de la pasteurización. También se realizó un análisis de macronutrientes en ocho frascos con distintos volúmenes de leche materna donada antes y después de una pasteurización programada.Resultados: No se objetivaron diferencias significativas en los siguientes parámetros analizados: tiempo de calentamiento de 58°C a 62,5°C, duración de la meseta, temperatura máxima durante la meseta y tiempo de exposición a temperaturas superiores a 58°C. El análisis de macronutrientes reveló diferencias significativas en el contenido graso, pero no en el proteico o el de lactosa.Conclusiones: La pasteurización de leche materna mediante un pasteurizador sin agua cumplió los estándares de calidad recomendados por la EMBA, independientemente de la cantidad de leche procesada en cada frasco y con cambios significativos en el contenido graso, pero no en contenido proteico o de lactosa. (AU)

Objective: Holder pasteurization is the technique used most frequently in milk banks to minimize the risk of transmission of infectious agents. Different pasteurization devices have been described that generally use hot water or air as heat sources. In our study, we analysed the quality of pasteurization achieved with a new automated water-free pasteurizer in a neonatal personalized nutrition unit in which donated milk from mothers of infants delivered at different gestational ages and of different postnatal ages is pasteurized.Material and methods: We analysed the temperatures of different phases of pasteurization with 8 external probes distributed evenly throughout the pasteurizer. We applied the optimal range criteria established by the European Milk Bank Association (EMBA) to assess the quality of pasteurization. We also analysed the macronutrient composition of 8 samples of donor human milk of different volumes before and after automated pasteurization.Results: We did not find no significant differences in the following parameters under study: time from 58°C to 62.5°C, duration of plateau, highest temperature during plateau and length of exposure to temperatures over 58°C. The macronutrient analysis showed significant changes in fat content but not in protein or lactose content.Conclusions: Holder pasteurization of human milk with a water-free pasteurizer met the quality standards recommended by the European Milk Bank Association independently of the quantity of milk pasteurized in each bottle and with significant changes in the fat content but not in the protein or lactose content. (AU)

Motivaciones, factores favorecedores y barreras para la donación de leche humana en madres lactantes de cinco ciudades de Colombia / Motivations, facilitating factors and barriers to human milk donation among breastfeeding mothers in five Colombian cities

Fundamentos: Colombia mantiene una reducida práctica de lactancia materna, lo que demuestra lanecesidad de fortalecer estrategias como la de los Bancos de Leche Humana (BLH). Esta investigación propusocomo objetivo identificar las representaciones sociales (RS) sobre donación de leche humana de madreslactantes residentes en cinco ciudades de Colombia donde funcionan BLH.Métodos: El estudio se abordó desde la teoría de las RS, se utilizaron métodos mixtos y diversas técnicas,como: la evocación jerarquizada, encuesta, entrevista semiestructurada y diario de campo.Resultados: se presentan los resultados de las 83 entrevistas realizadas a madres lactantes, clasificadas encuatro grupos según su experiencia y conocimiento del proceso de donación de leche humana.Conclusiones: la principal motivación para donar es la empatía y el deseo de ayudar a otros bebés, elprincipal factor favorecedor tiene relación con la gestión de los BLH, y la principal barrera para dejar de donarfue la falta de tiempo de las madres. (AU)

Background: Colombia has a low level of breastfeeding, which demonstrates the need to strengthenstrategies such as the Human Milk Banks (BLH). The objective of this research was to identify the socialrepresentations (SR) on human milk donation of breastfeeding mothers living in five cities in Colombia whereBLHs operate.Methods: The study was approached from the SR theory, using mixed methods and various techniques suchas: hierarchical recall, survey, semi-structured interview and field diary.Results: this article presents the results of the 83 interviews conducted with breastfeeding mothers, classifiedinto four groups according to their experience and knowledge of the process of human milk donation.Conclusions: the main motivation to donate is empathy and the desire to help other babies, the mainenabling factor is related to the management of BLHs, and the main barrier to stop donating was the mothers' lack of time. (AU)

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.

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.

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.

XV Congreso SEINAP. Experiencia, funcionamiento, investigación y futuro de los Bancos de Leche / XV Congreso SEINAP. Experience, functioning, research and future of Milk Banks

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XV Congreso SEINAP. Cómo se pone en marcha y cómo funciona un banco de leche. Experiencia del Hospital 12 de Octubre / XV Congreso SEINAP. How a milk bank is initiated and how it works. Experience of the Hospital 12 de Octubre

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