Donor Human Milk: Banking, Sharing, and Selling
Breast milk is liquid gold. Some mothers are blessed with more breast milk—more than what her baby needs—and are able to share the gift with others through milk banking or selling.
There is, however, a gap between evidence-based breastfeeding guidelines and practice, thus compromising the ability of the mother-baby dyad to meet established breastfeeding recommendations. Physicians have been lagging behind in their knowledge and use of banked donor human milk. They also may not be aware that their own patients may be obtaining milk—donated or sold—off the internet.
In light of the World Breastfeeding Week 2014, San Diego County Breastfeeding Coalition provided a mini-seminar, discussing the benefits and the risks of the various forms of donor human milk.
At the seminar that attracted dozens of health care providers, the coalition’s Dr. Nancy Wight (MD, IBCLC, FABM, FAAP) pointed out that because of the dissemination of research, quality improvement projects, and the best practice recommendations, the use of donor human milk in the NICU across the country has increased dramatically in the past decade.
“Historically,” Dr. Wight explained, “In the 1950s, people used mom’s milk and fresh donor milk for almost all infants.” Started 1970s, people started to use premature infant formula for preterm babies. Baby grow very fast with premature infant formula because this kind of formula is very high in protein. “But faster is not better!” noted Dr. Wight.
What helps the babies grow better in the NICU is, Dr. Wight said, human milk. Mother’s milk is the best choice, and donor human milk is the second best choice. “Human milk is food for nutritional management and a therapeutic agent that protects from, and reduces incidence and severity of various morbidities,” said Dr. Wight, “It a programming agent for genetic and biologic pathways. It’s a mechanism to involve mother and families in NICU care.”
Benefits of human milk for preemies includes host defense and immunologic programming, gastrointestinal development, special nutrition, improved neurodevelopment outcome as well as a physically and psychologically healthier mother. There are also economic and environmental benefits.
The breasts supplies what the baby lacks . Lactose supplies nutrients that meet baby’s energy requirements; lipase provides digestive enzymes to support the immature pancreatic function; sIgA provides protective factors to support immature gastrointestinal barrier function; epidermal growth factor supplies trophic factors for mucosal differentiation; and oligosaccharides provide prebiotics that support normal anti-inflammatory bacteria.
According to a California neonatologist survey done by Dr. Wight in 2001, 97% of California neonatologists always or usually recommend human milk for their NICU patients. However, the survey also found that there was little familiarity with the use of pasteurized donor human milk. It is likely that there is even less familiarity and usage of PDHM in many areas of the United States.
Some key areas of neonatologist’s concern identified were accessibility and logistics of obtaining milk, safety and infection control issues, social acceptability and legal issues, and nutritional adequacy and efficacy questions. A subsequent study done by Parker et al. 10 years later (2013) revealed a significant increase in knowledge about, and use of, pasteurized donor human milk in NICUs across the US.
Dr. Wight explained human milk processing and handling, saying that currently there are no federal regulations governing milk banks. Guidelines were established by the Human Milk Banking Association of North America (HMBNA), written in cooperation with Centers for Disease Control (CDC), American Academy of Pediatrics (AAP), and the Food and Drug Administration (FDA). in some states a Tissue Bank License is required.
According to HMBANA donor milk processing guidelines, all the mothers are carefully screened. That is to say, it is safer and important for mothers to donate and obtain milk through a licensed milk bank.
Meanwhile, informal sharing of human milk or buying human milk through the Internet is more risky. According to a retrospective review of serologic testing of potential human milk donors, among 1,091 potential donors, 3.3% came back with positive serology screening results including syphilis, Hepatitis B, Hepatitis C, HTLV, HIV.
Dr. Wight encouraged all to help increase milk donation to human milk banks so that all preterm and ill infants enjoy the benefits of human milk.
TO-WEN TSENG 曾多聞