Human Milk Bank in Croatia: initial experiences.

Donated human milk is the best substitute for breast milk in the case when the mother cannot feed her baby. Human milk banks provide safe and high quality donated human milk. That was the reason why the Human Milk Bank was established in the Croatian Tissue and Cell Bank at the Zagreb University Hospital Centre in January 2020. The Bank works in accordance with the Law on the Application of Human Tissues and Cells. In this paper, we present the results of the Bank work since from its opening until June 2020. Due to logistic reasons caused by the COVID-19 epidemic and the earthquake in Zagreb, the Human Milk Bank did not collect milk for 43 days. Milk was donated by 31 mothers. Their median age was 31 years and 81% of them had high education level. In 52% of cases, mothers started donating milk three months after giving birth. Most donors donated milk only once (45%). The median period of donation was 46 days. The majority (52%) of donors gave birth for the first time, in the expected term of childbirth (94%), birth weight was >2500 g. Only three of donors' children (9%) were in intensive care. A total of 175.5 L of milk were collected (mean 5.7 L per donor), of which 151.5 L met the requirements of input quality control, and 141 L were pasteurized. A critical number of viable aerobic and facultative bacteria were identified in 32.6% of milk pools prepared for pasteurization, and 8.9% after pasteurization. For clinical use, 78.7 L were dispensed in three neonatal intensive care units. The Human Milk Bank has already shown the importance of its activities during the first months of operation. In order to be able to meet the needs for donated human milk at the national level, it is necessary to constantly inform mothers about the importance of human milk and to promote its donation.Copyright © 2020 Croatian Paediatric Society. All rights reserved.

Sequential interventions to maintain the safety and service provisions of human milk banking in India: keeping up with the call to action in response to the COVID-19 pandemic.

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.

Human Milk Bank in a Rural Setup - A Success Story.

Background: This article describes the experience of a rural human milk bank, with the problems faced in first 6 months including the coronavirus disease (COVID) crisis and interventions leading to success. Methods: The study included individual counselling by dedicated counsellors, focused counselling of primipara mothers seeking the help of obstetricians, counselling of pre-term mothers by neo-natal nurses, periodically delivered information in post-natal wards, and counselling of grandmothers and husbands. Results: The COVID crisis was dealt with donations from reverse transcriptase-polymerase chain reaction-negative mothers with social distancing and mask use. Younger, educated, working mothers with normal delivery and from middle-income families were easy to counsel. Periodic announcements in wards significantly increased awareness about milk banks and donation. Pre-term mothers could be motivated when their baby was nil by mouth or they saw other babies in need of milk. Lactation support to mothers with breast problems, especially in primipara, helps in getting more donors. Counselling of fathers was easier than that of grandmothers. Conclusions: Structured awareness programs and counselling strategies along with education of grandmothers and husbands were very effective in increasing human milk donation.

Eight-year operation status and data analysis of the first human milk bank in East China.

BACKGROUND: Human milk banks (HMBs) are essential facilities for the selection, collection, testing, transportation,storage, and distribution of DHM for special medical needs. The aim of this analysis was to analyze the operation status and data over the last 8 years of operation of the first human milk bank (HMB) in East China. METHODS: Data related to the costs, donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB for the period August 1, 2013 to July 31, 2021. RESULTS: Over the 8 years of operation, 1,555 qualified donors donated 7,396.5L of qualified milk at a cost of ¥1.94 million($306,051), with the average cost per liter of donor human milk being ¥262.3($41.4). The donors were between 25 and 30 years of age, and the majority (80.1%) were primipara. All the donated milk was pasteurized and subjected to bacteriological tests before and after pasteurization: 95.4% passed the pre-pasteurization tests, and 96.3% passed the post-pasteurization tests. A total of 9,207 newborns received 5,775.2L of pasteurized donor milk. The main reason for the prescription of donor human milk was preterm birth. As a result of continuous quality improvements, January 2016 witnessed a significant increase in the volume of qualified DHM and the number of qualified donors. However, in 2020, as a result of the restrictions related to the COVID-19 pandemic, the volume of qualified DHM and the number of qualified donors decreased. CONCLUSIONS: Over its 8 years of operation, our HMB has made steady quality improvements in its screening and information processes. Continuous quality improvement is on ongoing need, along with recruiting more qualified donors and collecting donor human milk for vulnerable newborns.

Discuss and Share Experiences in Implementing FCC Models in University of Hong Kong - Shenzhen Hospital (HKU-SZH)

Aim: To discuss and share experiences in implementing Family centered care (FCC) models in Hong Kong - Shenzhen Hospital (HKU-SZH). Met hods: At present, FCC has not been wel l implemented in China and most NICU adopt closed management. Since December 2013, our department has introduced the FCC concept and implemented 24-hour opening ward, providing family members with a series of services including ward rounds, progressive health education, palliative care, breast-feeding, cold chain support of breast milk, breast milk bank, family visit, followup after discharge, and mutual support group for family members. The above services were maintained during the COVID-19 period. Results: 10,615 newborns were treated from December 2013 to December 2020, the minimum gestational age of preterm infants treated successfully was 22+6 weeks and the minimum weight was 500g. The patient satisfaction rate in 2020 was 99.9%, and the average breastfeeding rate in 2020 was 84% while 83.4% of full-term infants and 90.2% of premature infants were breast-fed. (A multi-center survey of 974 cases of nutrition-related status of preterm infants in NICU in China reported that 13.6% of preterm infants were breast-fed during 2005-2006) The nosocomial infection rate from 2014 to 2020 was controlled between 0.41% and 2.02%. Literature showed that the incidence rate of nosocomial infection in neonatal care units of 17 grade A general hospitals in China from 2013 to 2014 was 3.35%. Conclusion: An open NICU based on the FCC concept is feasible and contributes to increased breastfeeding rates and patient satisfaction without increasing the incidence of nosocomial infections.

Human Milk Bank in Croatia: initial experiences

Donated human milk is the best substitute for breast milk in the case when the mother cannot feed her baby. Human milk banks provide safe and high quality donated human milk. That was the reason why the Human Milk Bank was established in the Croatian Tissue and Cell Bank at the Zagreb University Hospital Centre in January 2020. The Bank works in accordance with the Law on the Application of Human Tissues and Cells. In this paper, we present the results of the Bank work since from its opening until June 2020. Due to logistic reasons caused by the COVID-19 epidemic and the earthquake in Zagreb, the Human Milk Bank did not collect milk for 43 days. Milk was donated by 31 mothers. Their median age was 31 years and 81% of them had high education level. In 52% of cases, mothers started donating milk three months after giving birth. Most donors donated milk only once (45%). The median period of donation was 46 days. The majority (52%) of donors gave birth for the first time, in the expected term of childbirth (94%), birth weight was >2500 g. Only three of donors’ children (9%) were in intensive care. A total of 175.5 L of milk were collected (mean 5.7 L per donor), of which 151.5 L met the requirements of input quality control, and 141 L were pasteurized. A critical number of viable aerobic and facultative bacteria were identified in 32.6% of milk pools prepared for pasteurization, and 8.9% after pasteurization. For clinical use, 78.7 L were dispensed in three neonatal intensive care units. The Human Milk Bank has already shown the importance of its activities during the first months of operation. In order to be able to meet the needs for donated human milk at the national level, it is necessary to constantly inform mothers about the importance of human milk and to promote its donation.

The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study.

BACKGROUND: The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). METHODS: This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil's federal law recommendations. RESULTS: The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment's health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. CONCLUSIONS: In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

Trends and Dynamics in the First Four Years of Operation of the First Human Milk Bank in Vietnam.

BACKGROUND: Since 1979, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have recommended the use of pasteurized human milk from a human milk bank (HMB) to feed low birthweight (LBW) and preterm newborns as the 'first alternative' when mothers are unable to provide their own milk. However, they have not issued any guidelines for the safe establishment and operation of an HMB. This gap contributes to the demand for gathering experiences from HMB networks, especially those from lower-middle income countries. To fill this knowledge gap, this study examines the characteristics of donors, donation, pasteurization, and recipients during the first four years of operation in the first HMB in Vietnam. METHODS: Data about the donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB from 1 February 2017 to 31 January 2021. RESULTS: In the first four years of operation there were 433 donors who donated 7642 L of milk (66% from the community) with an increased trend in the amount of donated milk, donation duration, and average amount of milk donated by a donor. Approximately 98% of the donated milk was pasteurized, and 82% passed both pre- and post-pasteurization tests. Although the pass rate tended to increase with time, a few dips occurred. Of 16,235 newborns who received pasteurized donor milk, two thirds were in the postnatal wards. The main reason for the prescription of pasteurized donor milk was insufficient mothers' own milk in the first few days after birth. There was a decreased trend in the amount and duration of using pasteurized donor milk in both postnatal wards and the neonatal unit. CONCLUSIONS: The HMB has operated efficiently in the previous four years, even during the COVID-19 pandemic, to serve vulnerable newborns. Ongoing evidence-based adjustments helped to improve the operation to recruit suitable donors, to increase the access to and quality of raw donor milk, to improve the pasteurization process, and to meet the need of more newborns.

Human milk banks in the response to COVID-19: a statement of the regional human milk bank network for Southeast Asia and beyond.

BACKGROUND: The World Health Organization (WHO) recommendations on infant feeding in the context of COVID-19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother's own milk is not available. INSUFFICIENT GUIDANCE ON THE USE OF DONOR HUMAN MILK AND THE ROLE OF HUMAN MILK BANKS IN THE PANDEMIC RESPONSE: COVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding. The use of safe donor human milk accessed through human milk banks is also insufficiently recommended, even in countries with an existing human milk bank, leading to a gap in evidence-based management of COVID-19. This highlights long-standing challenges as well as opportunities in the safe, equitable, and resilient implementation of human milk banks in the region. CONCLUSIONS: This statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community.

Maintaining human milk bank services throughout the COVID-19 pandemic: A global response.

If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID-19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open-ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic-related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context-dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies.