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.

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 the "new Normal" on Stem Cell Laboratory Practices

Background: Covid-19 pandemic put before us new challenges regarding the procurement and organization of allogeneic hematopoetic progenitor cell (HPC) transplantation. Therefore, securing the cryopreserved graft before start of patient conditioning is recommended to reduce risks due to donor or recipient infection or transport disturbances. Quality control (QC) standards for autologous grafts are well established and translated to allogenic setting but the impact of factors such as prolonged storage and cell concentration during transport on cryopreservation and grafts recovery is not clear. Practice is to begin conditioning immediately after the graft is cryopreserved which opens up new questions regarding QC. New measures created extra workload for the stem cell laboratory and QC unit. Methods: We investigated the impact of cryopreservation on work load of the stem cell lab and graft QC issues. Data on allogenic mobilized peripheral blood HPC received, cryopreserved and infused during 2019. Were compared to the first 11 months of 2020. Results: in 2019. we received 25 HPC products for 25 patients which were infused fresh except one which was cryopreserved due to organisational issues of pediatric recipient conditioning. We cryopreserved 82 bags intended for donor lymphocyte infusions (DLI). In the first 3 quarters of 2020. we cryopreserved 129 bags (34 products, 33 patients) for the purpose of transplantation and DLI which is 1,5 times more than previously. By December number of cryopreserved bags went up to 189 (49 patients, 50 products) which is more than twofold higher along with 90 bags thawed and infused. Mean time from collection to cryopreservation was 51 hours (26,5h-67h). Our standard QC for cryopreserved HPC products includes viability assessment using 7-AAD and colony forming unit assay (CFU). with the start of pandemic, the decision on quality of cryopreserved products relies on acceptable results of flow cytometry analysis of cryovial sample thawed 48 hours after freezing. After informing the transplant unit (TU) of acceptable QC results conditioning is started. The median of CD45/7AAD viability of 98% (61-100) in native product dropped to 71,5% (30-93) in thawed cryovial sample whilst CD34/7AAD native viability of median 100% (97-100) held at median 96% (2-98) post thaw and the results of CFU assay were in accordance. One product with poor viability and recovery in all cryovials tests was further investigated, transplant bags were analysed only to confirm the total loss of cell viability (CD45/7-AAD 30%, CD34/7-AAD 0,3%). This raised questions of factors that could have contributed such as prolonged time from collection to cryopreservation (>67 hours) and inadequate dilution of fresh cells (>250x109/L WBC). Patient was postponed and haplo transplant was initiated which was complicated with Covid-19 infection of the donor starting GCSF. Conclusions: Recommended cryopreservation of HPC products is a substantial financial and workload burden for the stem cell laboratory and QC unit. Cryopreservation tends to triple in 2020. and additional thawing procedures take considerable amount of time of overstretched staff working in epidemiologically acceptable shifts. Additional QC results need to be timely and clearly communicated to the TU so that deviations can be resolved before the start of conditioning.