Donor human milk banking is a service which collects, screens processes and dispenses by prescription human milk that has been donated by nursing mothers who are not biologically related to the recipient infant. Because the milk is dispensed to an unrelated recipient, every precaution is taken to provide a safe product.
Banked human milk is a valuble nutritional and immunoligical resource for high needs infants. Proliferation of research documenting the importance of human milk for all infants has seen an increased interest in the development of human milk banks in many countries. In the US there are 7 dispensing and 1 research milk bank; the UK has 12, endorsed by the British Pediatric Association; France has 18 active milk banks and Australia is actively seeking to establish human milk banking.
The only Canadian milk bank, The Lactation Support Services at the BC Children's Hospital in Vancouver, BC, adheres to guidelines developed by the Human Milk Banking Association of North America, Inc., in consultation with the US Centres for Disease Control and Prevention and the Food and Drug Administration. (1)
Important point #1: Properly processed and screened donor human milk is not a vector for disease transmission. Where properly supervised and operated donor milk banks do not exist, and access to screened and processed milk is not possible, informal sharing of milk increases the risk of disease transmission from donor to recipient. There is no documented case of disease transmission from donor to recipient from milk dispensed by a milk bank following guidelines.
Important point #2: Heat treatment does not destroy all the beneficial qualities of human milk. Unlike other tissues and organs, human milk is the only one that can be heart treated and retain its beneficial properties and functions. (2) Although the composition is altered somewhat by heat treatment and freezing, immunoglobulins remain in significant amounts and important nutrients such as long chain polyunsaturated fatty acids are not affected. (3)
Some milk banks dispense milk only to premature infants (milk banks in the UK) (4), while others dispense to premature infants and to older infants with feeding problems (US). In Canada, the only milk bank serving the entire country dispenses strictly to the infant or child for whom there are no feeding alternatives left or for whom metabolic stress must be minimized. For example, Riddell prescribes donor human milk as post-surgical nutrition for repair of gastroschisis, omphalocoele and colostomy repair (5),(6). Infants healed faster, returned to full enteral feedings faster and had fewer complications resulting in the need for elemental formulas designed for adults.
Donor milk has also been used in Canada as nutrition in chronic renal failure cases. (7) Human milk places the least metabolic stress on failing kidneys because of its ideal electrolyte balance. It also provides adequate nutrition for growth in this group of infants who routinely have weight gain problems.
Cardiac anomalies and failure to thrive cases (8) also have benefited from the use of donor milk, as have feeding intolerance. When an infant is allergic to cow's milk protein or grain-based formula, donor milk provides optimum nutrition as well as a chance for damaged tissues to heal. For some of these children, multiple problems exist, e.g. the renal failure case who is allergic to cow's milk protein. For them, donor milk may be the difference between life and death.
Important point #3: For a small and critically ill population of infants and children, access to donor human milk is not a matter of choice but a question of life and death. When other feeding options have been exhausted, total parenteral nutrition and its many complications and side effects is all that remains. Total parenteral nutrition is an expensive stop-gap measure with a finite period of usefulness. It is an invasive procedure.
Important point #4: Donor human milk ameliorates symptoms and allows a better quality of life for those infants and children with terminal illnesses.
Important point #5: Donor human milk therapy promotes healing, growth and maturation of tissues and organ systems. It does so while causing the least amount of metabolic stress to the infant.
Important Point #6: Use of donor milk may prevent permanent damage and long term sequelae in infants. Lucas's work9 clearly shows that premature infants who receive at least some donor milk or their mother's own milk for the first month of life had considerably less risk of developing necrotising enterocolitis and the resultant nutritional effects for the entire life span.
Currently the Nutrition Committee of the Canadian Pediatric Society is working on a statement that would virtually ban milk banking in Canada. Despite attempts to educate the membership of the Committee about milk banking practices in the US and Canada, they continue to deny the benefits of donor milk and the safety of current practice, equating donor milk banking to wet nursing. In the face of such a statement, the last remaining milk bank in Canada is threatened and milk banking may become extinct in Canada. What does this mean for Canada's neediest children?
To summarize, donor human milk banking plays an important role in reducing mortality and morbidity in a small population of critically ill or premature infants (10), (11), (12). It remains a critically important piece of the child survival picture for both industrialized and emerging nations. Donor milk banking is safe when guidelines for donor screening and pasteurization are followed. Where donor human milk banking is not promoted and protected as a safe feeding method, women will go outside the health care system to seek what they know is best for their own infant.
All countries need to include donor human milk banking as part of the total maternal and child health policy, so that it is done safely and consistently and is accessible to infants and children in need. It is incumbent on every nation to start donor milk banks and to protect the one's they have, not close them. In supporting donor human milk banking we will truly be fostering a child friendly world.
REFERENCES 1. Human Milk Banking Association of North
America, Inc., L. Arnold LDW, Tully MR eds. Guidelines for
the establishment and operation of a donor human milk bank.
. West Hartford, CT. 1995. Back
2. Centres for Disease Control and Prevention: Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs. MMWR 43:No. RR-8,1994. Back
3. Luukkainen P. Salo MK, Nikkari T. The fatty acid composition of banked human milk and infant formulas. The choices of milk feeding for premature infants. European Journal of Pediatrics 154, 316-319, 1995. Back
4. British Pediatric Society. Guidelines for the establishment and operation of the human milk banks in the UK: the report of the ad hoc working party following the sorrento symposium on milk banking - March 1993. London. 1994. Back
5. Riddell D. Use of banked human milk for feeding infants with abdominal wall defects. Presented at the annual meeting of the Human Milk Banking Association of Nort America, Vancouver, BC, Canada October 1989. Back
6. Rangecroft L, et al. . A comparison of the feeding of the postoperative newborn with banked breast-milk or cow's milk feeds. Journal of Pediatric Surgery 13, 11-12, 1978. Back
7. Anderson A. Arnold LDW. Use of donor breastmilk in the nitrition management of chronic renal failure: three case histories. Journal of Human Lactation 9, 263-264, 1993. Back
8. Arnold LDW. Use of donor milk in the management of failure to thrive: case histories. Journal of Human Lactation 1,1137-140, 1995. Back
9. Lucas A. Cole T. Breast milk and necrotising enerocolitis. Lancet 336, 1519-1523, 1990. Back
10. Arnold LDW. Human milk for premature infants. Journal of Human Lactation. 9, 116-118, 1993. Back
11. Arnold LDW Use of donor milk in the treatment of metabolic disorders: Glycolytic pathway defects. Journal of Human Lactation 11, 51-53, 1995. Back
12. Asquith M. et al . Clinical uses, collection and banking of human milk. Clinical Perinatology 14, 173-185, 1987. Back
Thanks to Lois D.W. Arnold, MPH, IBCLC - Executive Director HMBANA
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