Donation barriers, enablers, patterns and predictors of milk bank donors in the United States and United Kingdom.

Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross-sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom-70% vs. United States - 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting-specific milk banking research.

A Rede de Bancos de Leite Humano lançou a 6° edição da rBLH em Dados

A sexta edição da rBLH em Dados já se encontra disponível com as informações do monitoramento anual de produção da Rede Brasileira de Bancos de Leite Humano. Informações relacionadas às atividades desenvolvidas no âmbito da Rede Global de Bancos de Leite Humano no fortalecimento das estratégias para promoção do aleitamento materno e consequentemente, do aumento das possíveis mães doadoras, associado ao acesso ao leite processado conforme as normativas de qualidade e higiene é uma estratégia primordial para que finalmente a mortalidade neonatal precoce possa ser reduzida.

Controle mensal de funcionamento de bancos de leite humano e postos de coleta de leite humano: dados de produção / Control mensual del funcionamiento de los bancos de leche humana y centros de recolección de leche humana: datos de producción / Monthly operation control of banks human milk and human milk collection stations: production data

Esta Norma Técnica tem por objetivo estabelecer os critérios necessários para o cadastro e manutenção das informações mensais dos Bancos de Leite Humano e Postos de Coleta de Leite Humano no sistema de informação, segundo as diretrizes definidas pela Rede Brasileira de Bancos de Leite Humano, visando a garantia da qualidade nestes serviços e sua certificação

Esta Norma Técnica tiene como objetivo establecer los criterios necesarios para el registro y mantenimiento de las informaciones mensuales de los Bancos de Leche Humana y de los Centros de Recolección de Leche Humana en el sistema de información, de acuerdo con las directrices establecidas por la Red Brasileña de Bancos de Leche Humana, con el fin de garantizar la calidad de estos servicios y su certificación.

Impacto de la pandemia por SARS-CoV-2 en un banco de leche humana / Impact of the SARS-CoV-2 pandemic on a human milk bank

Introducción: la pandemia originada por el SARS-CoV-2 provocó la declaración del estado de alarma sanitaria entre marzo y junio de 2020 en España. Los bancos de leche materna han visto afectada su actividad durante este periodo, siendo necesario implementar nuevas medidas para promocionar la donación de leche y disminuir el impacto en la actividad. Método y objetivo: el objetivo del estudio es evaluar el impacto del estado de alarma decretado desde el 14 de marzo al 22 de junio de 2020 en el Banco de Leche del Hospital Virgen de las Nieves de Granada, en comparación con el mismo periodo del año previo. Para ello se ha realizado un estudio descriptivo retrospectivo en el que se han tenido en cuenta los indicadores de actividad del Banco de Leche de forma global y se han comparado los datos del Banco de Leche del Hospital Universitario Virgen de las Nieves, ubicado en Granada, con los datos de los centros periféricos que colaboran con el mismo. Resultados: durante el primer estado de alarma de 2020 hubo una disminución global de las inscripciones de nuevas donantes, del número de donantes que donaron leche, del volumen de donación media por madre y del volumen total de leche cruda recibida y pasteurizada. A pesar de ello, en el banco de leche de Granada aumentaron las nuevas inscripciones durante este periodo, así como el número de donantes que donaron leche. Conclusión: las medidas adoptadas en el banco de leche ubicado en Granada, como incentivar la donación de leche entre las madres con niños ingresados en la Unidad Neonatal, aumentar la información a las madres y recoger la leche donada a domicilio, permitieron atenuar el impacto de la pandemia, garantizando la seguridad. (AU)

Introduction: the pandemic caused by SARS-CoV-2 led to the declaration of the state of sanitary alarm between March and June 2020 in Spain. The activity of human milk banks was affected during that period, making it necessary to implement new measures in order to promote milk donation and diminish said impact. Method and objective: the aim of the study was to evaluate the impact of the state of alarm decreed from March 14 to June 22, 2020 on the breastmilk bank at Hospital Virgen de las Nieves, Granada, Spain, in comparison with the same period during the previous year. To that end, a retrospective descriptive study was undertaken in which the activity indicators of the breastmilk bank were collected and compared to data from the milk bank at Hospital Virgen de las Nieves and peripheral collaborating centers. Results: during the first state of alarm in 2020 a global reduction was seen in new donor registrations, number of donors who donated milk, donated mean volume per mother, and total volume of received and pasteurized milk. However, new registrations and number of donors who donated milk during this period increased in Granada's breastmilk bank. Conclusion: the new measures adopted in the breastmilk bank in Granada, such as encouraging milk donation in mothers with admitted newborns in the Neonatal Unit, increasing information given to mothers, and home collection of donated milk, allowed to attenuate the impact of the pandemic while guaranteeing safety. (AU)

[Impact of the SARS-CoV-2 pandemic on a human milk bank]. / Impacto de la pandemia por SARS-CoV-2 en un banco de leche humana.

INTRODUCTION: Introduction: the pandemic caused by SARS-CoV-2 led to the declaration of the state of sanitary alarm between March and June 2020 in Spain. The activity of human milk banks was affected during that period, making it necessary to implement new measures in order to promote milk donation and diminish said impact. Method and objective: the aim of the study was to evaluate the impact of the state of alarm decreed from March 14 to June 22, 2020 on the breastmilk bank at Hospital Virgen de las Nieves, Granada, Spain, in comparison with the same period during the previous year. To that end, a retrospective descriptive study was undertaken in which the activity indicators of the breastmilk bank were collected and compared to data from the milk bank at Hospital Virgen de las Nieves and peripheral collaborating centers. Results: during the first state of alarm in 2020 a global reduction was seen in new donor registrations, number of donors who donated milk, donated mean volume per mother, and total volume of received and pasteurized milk. However, new registrations and number of donors who donated milk during this period increased in Granada's breastmilk bank. Discussion: the new measures adopted in the breastmilk bank in Granada, such as encouraging milk donation in mothers with admitted newborns in the Neonatal Unit, increasing information given to mothers, and home collection of donated milk, allowed to attenuate the impact of the pandemic while guaranteeing safety.

INTRODUCCIÓN: Introducción: la pandemia originada por el SARS-CoV-2 provocó la declaración del estado de alarma sanitaria entre marzo y junio de 2020 en España. Los bancos de leche materna han visto afectada su actividad durante este periodo, siendo necesario implementar nuevas medidas para promocionar la donación de leche y disminuir el impacto en la actividad. Método y objetivo: el objetivo del estudio es evaluar el impacto del estado de alarma decretado desde el 14 de marzo al 22 de junio de 2020 en el Banco de Leche del Hospital Virgen de las Nieves de Granada, en comparación con el mismo periodo del año previo. Para ello se ha realizado un estudio descriptivo retrospectivo en el que se han tenido en cuenta los indicadores de actividad del Banco de Leche de forma global y se han comparado los datos del Banco de Leche del Hospital Universitario Virgen de las Nieves, ubicado en Granada, con los datos de los centros periféricos que colaboran con el mismo. Resultados: durante el primer estado de alarma de 2020 hubo una disminución global de las inscripciones de nuevas donantes, del número de donantes que donaron leche, del volumen de donación media por madre y del volumen total de leche cruda recibida y pasteurizada. A pesar de ello, en el banco de leche de Granada aumentaron las nuevas inscripciones durante este periodo, así como el número de donantes que donaron leche. Discusión: las medidas adoptadas en el banco de leche ubicado en Granada, como incentivar la donación de leche entre las madres con niños ingresados en la Unidad Neonatal, aumentar la información a las madres y recoger la leche donada a domicilio, permitieron atenuar el impacto de la pandemia, garantizando la seguridad.

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.

Inadequate Content of Docosahexaenoic Acid (DHA) of Donor Human Milk for Feeding Preterm Infants: A Comparison with Mother's Own Milk at Different Stages of Lactation.

A cross-sectional single-center study was designed to compare the fatty acids profile, particularly docosahexaenoic acid (DHA) levels, between milk banking samples of donor human milk and mother's own milk (MOM) for feeding preterm infants born before 32 weeks' gestation. MOM samples from 118 mothers included colostrum (1-7 days after delivery), transitional milk (9-14 days), and mature milk (15-28 days and ≥29 days). In the n-3 polyunsaturated fatty acids (PUFAs) group, the levels of α-linolenic acid (C18:3 n3) and DHA (C22:6 n3) showed opposite trends, whereas α-linolenic acid was higher in donor human milk as compared with MOM, with increasing levels as stages of lactation progressed, DHA levels were significantly lower in donor human milk than in MOM samples, which, in turn, showed decreasing levels along stages of lactation. DHA levels in donor human milk were 53% lower than in colostrum. Therefore, in preterm infants born before 32 weeks' gestation, the use of pasteurized donor human milk as exclusive feeding or combined with breastfeeding provides an inadequate supply of DHA. Nursing mothers should increase DHA intake through fish consumption or nutritional supplements with high-dose DHA while breastfeeding. Milk banking fortified with DHA would guarantee adequate DHA levels in donor human milk.

Banco de leche humana (BLH): una estrategia de apoyo para la atención de neonatos / Human milk bank (HMB): a support strategy for newborn care

Introducción: la lactancia materna ha demostrado grandes beneficios para el recién nacido. En vista de que hay factores que afectan la correcta lactancia, en 2007 se crearon los bancos de leche materna y Colombia hace parte de esta iniciativa en pro de la niñez. Objetivo: identificar la utilización del banco de leche humana (BLH) de la ESE Hospital San Rafael de Fusagasugá, Colombia entre julio 2012 y junio 2016. Metodología: estudio descriptivo de corte transversal, con muestra de 1282 nacidos en el período que utilizaron el BLH. Resultados y discusión: entre los factores que llevaron al uso del BLH en estos menores están la baja producción de leche en la madre en 53,7%, cirugía materna 3,5%, mamá con bajo nivel cognitivo 0,2%, succión leve o pobre en 9,6%, madre ausente 0,4%, recién nacido que requirió hospitalización 4,6%, pezón invertido o plano 2,5% y labio leporino 0,5%. Conclusión: se pudo determinar que 22,7% de los niños que nacieron en el municipio necesitaron el servicio del banco de leche materna, logrando visualizar las bondades del mismo, brindando la oportunidad para que lo pudieran utilizar en la misma zona de nacimiento sin necesidad de desplazarse, evitando las subsiguientes consecuencias que ello desencadena en la familia y el recién nacido.

Introduction: breastfeeding has shown great benefits for the newborn. In view of the fact that there are factors affecting proper breastfeeding, nursing mothers ́ milk banks were created in 2007 and Colombia is part of this initiative on behalf of children. Objective: to identify the use of the human milk bank (HMB) at ESE Hospital San Rafael in Fusagasugá, Colombia between July 2012 and June 2017. Methodology: descriptive cross-sectional study, with a sample of 1282 newborns delivered in said period using HMB. Results: among the factors that led to the use of HMB in these children are the mother ́s low milk production in 53.7%, maternal surgery 3.5%, mother with low cognitive level 0.2%, mild or poor suction 9.6%, absent mother 0.4%, newborn requiring hospitalization 4.6%, inverted or flat nipple 2.5% and cleft lip 0.5%. Conclusion: it could be determined that 22.7% of the children born in the municipality needed the service of the mother ́s milk bank, managing to visualize the benefits of it, providing the opportunity for them to use it in the same area of birth without having to move, avoiding the subsequent consequences that this triggers in the family and newborn.

[Nutritional composition of donor human milk according to lactation period]. / Composición nutricional de la leche materna donada según el periodo de lactancia.

INTRODUCTION: Introduction: when own mother´s breast milk is unavailable, donor human milk is the best option to guarantee the nutritional requirements of preterm or ill newborns. Objectives: to analyze the macronutrient composition of donor breast milk and its evolution over lactation periods. Material and methods: we retrospectively analyzed the nutritional composition of 822.423 L of donor breast milk from 160 donors at the human milk bank of a third-level hospital between February 1, 2017 and December 31, 2019. Results: lipid and carbohydrate composition remains constant throughout lactation. However, protein content decreases initially to increase again starting in the second year of lactation. Conclusions: donor human milk banks should be aware of the variations in macronutrient composition donor human milk shows in order to optimize nutrition for preterm newborns.

INTRODUCCIÓN: Introducción: cuando no se dispone de leche materna propia, la leche materna donada es la mejor alternativa para asegurar los requerimientos nutricionales de los recién nacidos prematuros o enfermos. Objetivos: conocer el contenido de macronutrientes de la leche materna donada y cómo varían estos en los distintos periodos de la lactancia. Material y métodos: se analizó de forma retrospectiva la composición nutricional de 822,423 litros de leche materna donada, procedentes de 160 donantes del banco de leche materna de un hospital de tercer nivel entre el 1 de febrero de 2017 y el 31 de diciembre de 2019. Resultados: el contenido en lípidos y carbohidratos se mantiene constante a lo largo de la lactancia; sin embargo, el contenido proteico disminuye inicialmente para luego volver a aumentar a partir del segundo año de lactancia. Conclusiones: los bancos de leche materna deben conocer las variaciones del contenido en macronutrientes de la leche donada para optimizar la nutrición del recién nacido prematuro.

Donor Human Milk for Preterm Infants: A Cost-Consequence Analysis of Alternative Preservation Methods.

OBJECTIVES: To perform cost-consequence and cost-effectiveness analyses of 2 methods of donor human milk (DHM) preservation-Holder pasteurization (HoP) and high-pressure processing (HPP)-in human milk banks in Poland. METHODS: We used the results of the LACTOTECHnology as an answer to special nutritional requirements of preterm infants (LACTOTECH) preclinical study on the impact of different preservation methods on the content of bioactive milk components. The cost analysis was performed from the hospital perspective. To estimate the Diagnosis-Related Group (DRG) tariff for enteral feeding with DHM preserved by HPP, the pricing process used by the Polish health technology assessment agency (Agencja Oceny Technologii Medycznych i Taryfikacji) was followed. One-way deterministic and probabilistic sensitivity analyses on costs and human milk component parameters were undertaken. RESULTS: HPP maintains an average of 55% more potentially beneficial DHM components than HoP, but is more expensive (€35 750 vs €5066). The DRG tariff relating to milk from human milk banks preserved by the HPP method should be about €54 (130%) higher than with HoP. The cost-effectiveness ratio ranged from €0.84 to €10.27 per 1% gain in the active compound content in a daily portion of DHM. Sensitivity analysis showed that the cost of an HPP device had the most significant impact on pascalization expenses. CONCLUSIONS: HPP is a potentially more beneficial method of DHM preservation than HoP, but it is also about 7 times more expensive. Because of high pascalization costs, the cost-effectiveness analysis based on clinically significant endpoints will play an important role in decision making regarding the implementation of HPP into clinical practice of human milk banking.

Prevalence and predictors of donor milk programs among U.S. advanced neonatal care facilities.

OBJECTIVE: (1) Determine national prevalence and predictors of donor milk programs among levels 2-4 advanced neonatal care facilities; (2) describe characteristics of donor milk programs. STUDY DESIGN: We randomly selected 120 U.S. hospitals with levels 2-4 advanced neonatal care facilities among each of four U.S. regions and surveyed the medical directors from July 2017 to November 2017 regarding donor milk use. We weighted responses according to the number of birthing hospitals in each region. RESULTS: Response rate was 213/480 (44%). Twenty-eight percent of level 2 and 88% of levels 3 and 4 neonatal care facilities had donor milk programs. Donor milk programs occurred more often in the South vs. Northeast (aOR 3.7 [1.1, 12.5] and less often in safety-net hospitals (≥75% Medicaid patients) vs. nonsafety-net hospitals (aOR 0.3 [0.1, 0.8]). CONCLUSION: In 2017, the vast majority of levels 3 and 4 neonatal care facilities had donor milk programs but disparities existed according to the safety-net hospital status and region.

Cost Analysis of Operating a Human Milk Bank in China.

BACKGROUND: Establishing a human milk bank for the benefit of premature newborns who are unable to receive their mothers' milk for various reasons is a common initiative. To date, 19 human milk banks have been established in China; however, data associated with human milk banks are lacking, including information on the operational costs, guidelines, and regulatory systems for human milk banks in China. RESEARCH AIM: Our study aim was to conduct a cost analysis for the human milk bank at Shanghai Children's Hospital. METHODS: A management accounting approach, based on the activity-based costing method, was used to develop a cost model for donor human milk. The data were collected retrospectively and included budget plans, financial and expenditure reports, databases, and interviews with the staff and managers at the Shanghai Children's Hospital Human Milk Bank in 2017. RESULTS: In 2017, the total volume of qualified donor human milk was 933.70 L, of which 842.71 L (90%) was frozen and 90.99 L (10%) was freshly donated on site. The total annual cost to provide milk for 212 high-risk infants in 2017 was US$156,923, and the unit cost was US$168/L. CONCLUSIONS: The operating costs of human milk banks in China are similar to those in other countries internationally, but these costs are so large that they require government and society support for funding and milk donation. Therefore, ongoing breastfeeding support for mothers and measures to reduce the operating costs of human milk banks should be advocated.

The Influence of Donor Milk Supplementation on Duration of Parenteral Nutrition in Preterm Infants.

BACKGROUND: Data are limited on the association between the use of donor human milk and improvements in feeding tolerance. OBJECTIVE: To determine the influence of the duration of parenteral nutrition on the growth and morbidity of the breastfed newborn when using donated human milk in the absence of mother's own milk. METHODS: We conducted a retrospective study before and after the intervention that compared two groups of newborns (N = 284; each group n = 142). We used a convenience sample of all newborns ≤32 weeks gestation consecutively admitted in a single unit before (Group 1 between December 2012 and May 2014) or after (Group 2 between October 2014 and December 2016) the availability of donor human milk. In Group 2, donor human milk was administered at least 3 to 4 weeks or until the baby weighed 1,500 g. Weight was recorded daily and length and head circumference weekly. Parenteral nutrition was continued until enteral feeding volume reached 120 ml/kg/day. Additional variables measured were the number of days with a central venous catheter, age that the enteral feeding volume reached 150 ml/kg/day, and duration of stay. RESULTS: The duration of parenteral feeding was the same before and after: 12 (8.23) and 11 (7.19) days (p = .822). The z scores for weight and height of newborns was lower in Group 2 = -1.8 (1.0) and -2.3 (1.1) and Group 1 = -1.2 (1.1) (p < .001) and -1.8 (1.4) (p = .005). CONCLUSION: We did not find an association between the administration of donor human milk as a supplement to mother's own milk and reduced number of days of parenteral nutrition. Back translation by Laurence Grummer-Strawn.

Supporting mothers, protecting babies for long-term health: establishing a pasteurised human milk bank.

It is now very clear that early feeding practices have lifelong implications for an individual's health as well as economic and public health consequences. This article summarises some of the important reasons to prioritise breast milk feeding and introduces the Christchurch Neonatal Intensive Care Human Milk Bank. This Milk Bank was opened in 2014 to support babies and their families with the provision of pasteurised donor milk. The primary goals were to support mothers while they established their own milk supply, reduce exposure to parenteral nutrition and formula and reduce the risk of necrotising enterocolitis in this vulnerable population.

A Landscape Analysis of Human Milk Banks in India.

OBJECTIVES: To evaluate the existing status of human milk banks in India with reference to infrastructure, human resources, funding mechanisms, operating procedures and quality assurance. METHODS: A pretested questionnaire was administered to 16 out of 22 human milk banks across India, operational for more than one year prior to commencing the study. RESULTS: 11 (69%) milk banks were in government or charitable hospitals; only 2 (12.5%) were established with government funding. 8 (50%) had a dedicated technician and only 1(6%) had more than five lactation counsellors. Milk was collected predominantly from mothers of sick babies and in postnatal care wards followed by pediatric outpatient departments, camps, satellite centers, and homes. 10 (63%) reported gaps between donor milk demand and supply. 12 (75%) used shaker water bath pasteurizer and cooled the milk manually without monitoring temperature, and 4 (25%) pooled milk under the laminar airflow. 10 (63%) tracked donor to recipient and almost all did not collect data on early initiation, exclusive breastfeeding or human milk feeding. CONCLUSIONS: Our study reports the gaps of milk banking practices in India, which need to be addressed for strengthening them. Gaps include suboptimal financial support from the government, shortage of key human resources, processes and data gaps, and demand supply gap of donor human milk.

Donor Milk Policies for Level 1 Newborn Care: A Descriptive Analysis.

Background and Objectives: Providing pasteurized donor human milk (DHM) to healthy newborns is an emerging practice. The content of hospital policies that govern this practice is unknown. Materials and Methods: We collected policies from 15 Northeast U.S. hospitals through (1) a 2017 survey on DHM use and (2) an e-mail listserv of levels 1 and 2 newborn care staff maintained by a regional milk bank. Two authors reviewed each policy and identified how they addressed three predetermined themes: who is eligible to receive DHM, how DHM is used and described, and how lactation is supported. Responses were compared, discussed, and reconciled. Level 1 newborn care was defined as basic care for healthy newborns ≥35 weeks' gestation. Results: Thirteen of 15 policies stated criteria for DHM eligibility, most commonly as a bridge until mother's supply comes in (73%) or for infant medical conditions (67%). All required consent for DHM. Most did not limit number of days infants could receive DHM (60%). Nine specified that DHM be discarded 24 hours after thaw, whereas five recommended discarding at 48 hours. Although many (53%) policies endorsed human milk as the preferred diet for newborns, only 27% specifically endorsed DHM as the preferred supplementation type. Parent education (73%) was emphasized, but few (27%) discussed the importance of establishing mother's milk supply. Conclusions: Many DHM policies address eligibility criteria for receiving DHM and show how to provide DHM, but few address how to support lactation while DHM is provided, which may be crucial for optimizing long-term breastfeeding outcomes.

Nurses' Views on Using Pasteurized Donor Human Milk for Hypoglycemic Term Infants.

PURPOSE: The purpose of this study was to explore maternal child nurses' knowledge and beliefs about using pasteurized donor human milk (PDHM) to treat newborns with hypoglycemia. Pasteurized donor human milk has been used for decades in neonatal intensive care units, but its use is relatively new in the well-baby population. STUDY DESIGN AND METHODS: Focus groups of maternal child nurses were conducted to explore this topic. RESULTS: Six focus groups that included a total 20 nurses were held. Four themes were identified: 1) nurses presumed safety of PDHM but lacked knowledge, 2) nurses' role as patient-family advocate, 3) nurses' logistical concerns about implementation of PDHM, and 4) nurses lacked clarity on formal milk sharing versus PDHM. CLINICAL IMPLICATIONS: As the use of PDHM increases for well babies, nurses will need more education about PDHM, its safety profile, its use in breastfeeding support and protection of the infant microbiome, and how PDHM differs from informal milk sharing. Nurses play an important role in helping parents weigh risks and benefits of using PDHM or formula when supplementation is needed during the hospital stay. It is important that nurses feel confident in their own knowledge and ability to address parental concerns so they can advocate for their patients and support parental decision-making.

Expressing Motherhood: Wet Nursing and Human Milk Banking in Brazil.

In early twentieth-century Brazil the proponents of human milk banking considered this development to signal the end of wet nursing and the start of a whole new day, one altogether better for the paid donors of human milk, their children, and the children in need of human milk. But wet nursing persisted alongside the new human milk banks for most of the twentieth century. Moreover, as this paper argues, the organizers and directors of milk banks drew on and constructed ideas about wet nursing, and about the generations of poor Afro-Brazilian women who had performed this labor, in the design and operation of the first milk banks.

Peer-to-Peer Human Milk Sharing: Recipient Mothers' Motivations, Stress, and Postpartum Mental Health.

BACKGROUND: Some mothers who cannot breastfeed-partially or completely-choose to feed their infants human milk donated from a peer. Few studies have examined mothers' experiences with using donor milk; none has examined whether or not mothers' stress and mental health are associated with using donor milk from a peer. METHODS: Researchers conducted semistructured individual interviews with mothers from the United States and Canada (N = 20) to answer the following questions: (a) what are recipient mothers' motivations for participation in peer-to-peer breast milk sharing and (b) what is the relationship between receiving donated milk and mothers' stress and mental health postpartum? Transcripts were coded using an inductive approach and principles of grounded theory were used to analyze data. RESULTS: Data were organized under two themes: (a) motivations for using milk from a peer and (b) milk-sharing and stress-related experiences. Motivations included health benefits, medical need, and preference for human milk over formula. Factors inducing stress were as follows: logistical stressors of securing donor milk and fear of running out of milk. Factors reducing stress were as follows: donor milk provided relief and comfort and its use reduced mothers' self-reported symptoms of postpartum depression and anxiety. CONCLUSIONS: Mothers participated in peer-to-peer breast milk sharing primarily because of health benefits for children. However, participation also had important psychological benefits for some mothers. Additional research and open discourse are needed to support mothers who choose to use milk from a peer and to promote safety of this practice.