Why Human Donor Milk?
The benefits of pasteurised donor milk are that the human milk, which is pasteurised for use, contains over 200 components that are useful for growth and health for an infant. It assists the baby to build a healthy immune system and also acts as protection from infections. It contains easily digestible proteins, reduces the risk of bowel problems in preterm infants and contributes to nervous system and brain growth.
History of Human Milk Banks, Donor Milk
Feeding a baby with another woman's breast milk has occurred since time immemorial. In some cases it was merely a matter of convenience when mothers, particularly wealthy ones, did not want to suffer what they perceived as the 'indignity of breastfeeding', so wet nurses were employed and this became a thriving industry in some countries. Wet nurses provided milk for healthy babies who were able to actively suckle at the breast, but sick, small premature babies, who were unable to latch and breastfeed, were unable to benefit from being given to a wet nurse for nourishment.[1]
The first recorded milk bank opened in Vienna in 1909. Wet nurses expressed their breasts and this milk was given to sick babies. Now there are hundreds of milk banks worldwide. The 1980s saw the decline of milk banks, not only due to the rise in HIV infections, but also partly due to the development of formula milks designed for preterm babies by industry. Although it was known that pasteurisation deactivated the HIV virus, (HIV did not result in a decline in blood banking) the perceived costs of screening potential donor mothers and the processes involved in donor milk banking, versus the easy availability of preterm formula, resulted in many, but not all, milk banks closing globally.
With increasing knowledge of the unique composition of breast milk and the detrimental health effects of formula milk, the interest in milk bank development has re-emerged globally. The protective components of breast milk such as the immunoglobulins IgA and SIgA, the anti-bacterial/anti-infective proteins lactoferrin and lysozyme, and the many oligosaccharides that provide bioactive factors, prebiotic, immunomodulatory & antimicrobial effects, have helped reduce necrotising enterocolits (NEC) and late onset sepsis rates in NICU babies.
[1] American Academy of Paediatrics. (2012). A policy statement: Breastfeeding and the use of human milk. Paediatrics, doi: 10.1542/peds.2011-3552. (update on the 2005 statement)
From Donor to Baby - The Process
When donated milk is received it is stored in a holding freezer until a donors blood test results become available and the milk is cleared for use. Known as raw milk at this stage it can be stored frozen for up to three months until it is pasteurised. The raw milk is defrosted and each donor's milk is pooled into two to three batches (milk from different donors is not mixed) for tracking purposes. The milk is placed in bottles and pasteurised using the Holder method – heating the milk in a water bath to 62.5C for thirty minutes and quickly chilling the milk to 4C. The milk is then measured into various sized bottles, and refrozen for up to three months for use in the neonatal unit.
The Sterifeed Pasteuriser holds up to nine litres of milk. Microscopy samples of milk are taken pre and post-pasteurisation from every batch and the milk is held in a ‘quarantine’ status until results are verified after forty-eight hours. A paper tracking and tracing inventory allows the milk to be tracked from donor to recipient.
Milk Bank Process
The below video outlines the process.