Human Milk Banks: A Narrative Review

Human Milk Banks: A Narrative Review *José-Sousa Vale1,(MD); João Miranda2,(MD); Joana-Sousa Nunes3,(MD); Mariana Veiga4,(MD) 1. ARSLVT, USF Marginal - R. Egas Moniz 9010, Piso 2, 2765-618 São João do Estoril, Lisboa, Portugal. 2. Serviço Pediatria Centro Hospitalar Vila Nova Gaia/Espinho - R. Conceição Fernandes 1079, Vila Nova de Gaia, 4434502 Vila Nova de Gaia. 3. Serviço Ginecologia/Obstetrícia Hospital Senhora da Oliveira Guimarães, R. dos Cutileiros 114, Creixomil, 4835-044 Guimarães. 4. Serviço de Ginecologia/Obstetrícia Hospital de Cascais Dr. José Almeida - Avenida Brigadeiro Victor Novais Gonçalves 2755-009 Alcabideche. ARTICLEINFO ABSTRACT Article type: Original article Introduction: Not all mothers can provide sufficient milk, and infants admitted to a neonatal ward are less likely to be exclusively breastfed. Current recommendations are for the use of mother’s own milk (MOM), and pasteurized donor human milk (PDHM) is the next best choice. The present article was prepared as a tool to study the optimal organization of Human milk banks (HMB) and to contribute to the diffusion of the culture and promotion of breastfeeding and summarize current best practices for the handling of PDHM. Materials and Methods: PubMed, Embase and Cochrane were searched using the search term combination “human milk banks” OR “pasteurized donor human milk”. Results: HMB are responsible for human milk (HM) promotion, collection, processing, protection, quality control, distribution and support. The quality of expressed HM is the result of adequate hygienic-sanitary conditions, from expression to administration, and the evaluation of nutritional, immunological, chemical, and microbiological characteristics. It is essential a multidisciplinary team to support an HMB. Conclusion: In settings where donor HM supplies are limited, prioritization of infants by medical status is key. The manner in how investments in human milk feeding are applied should be targeted. The purchase cost of PDHM should be compared with the purchase costs of other nutrition interventions routinely used in care for critically ill neonates. Article History: Received:.03-Aug-2019 Accepted: 15-Mar-2020 Keywords: Breast Feeding, Infant Formula, Milk Banks, Low Birth Weight, Very Low Birth Weight. Please cite this paper as: Vale JS, Miranda J, Nunes JS, Veiga M. Human Milk Banks: A Narrative Review. Journal of Patient Safety and Quality Improvement. 2020; 8(1):45-52. Doi: 10.22038/psj.2020.42356.1239 Introduction Not all mothers can provide sufficient milk, and infants admitted to a neonatal ward are less likely to be exclusively breastfed. Current recommendations are for the use of mother’s own milk (MOM), and pasteurized donor human milk (PDHM) is the next best choice. Considerable global variation exists in the storage, handling, fortification and feeding of PDHM (1). There are multiple avenues for compromising the nutritional and bioactive components of HM. It is pumped, transferred among containers, stored, warmed, fortified, and fed via infusion. So, HM is easily contaminated during these processes and can serve as an excellent medium for bacterial growth. *Coresponding author: ARSLVT, USF Marginal - R. Egas Moniz 9010, Piso 2, 2765-618 São João do Estoril, Lisboa, Portugal E-mail: 45 Vale JS, et al The present article serves as a tool to study Human Milk Banks (HMB) in a narrative review, aiming to explore the existing literature, by describing its organization, management and procedures, and to determine the optimal requirements to establish a new HMB. Also, this manuscript aims to contribute to the diffusion of the culture and promotion of breastfeeding and summarize current best practices for human milk handling within the hospital setting. Materials and Methods A search of literature was conducted to identify papers regarding Milk Banks and the handling of HM and PDHM. The authors identified sources (abstracts and full text articles) from the PubMed, Cochrane and Embase databases from 2000 to December 2018. Full texts published during 2019, referring to abstracts presented prior to December 2018 were also identified and analyzed. The search was narrowed to articles written in English. The search strategy adopted the MeSH terms search combination Human Milk Banks” OR “pasteurized donor human milk”. All titles were checked for describing Milk Banks and the handling of HM and PDHM. Abstracts and then full texts were reviewed to select systematic reviews, meta-analyses, longitudinal, prospective and retrospective studies, and literature reviews. Meta-analyses and systematic reviews on the topics were preferred. Besides, the reference lists of the identified studies were manually reviewed to identify complementary publications. During the screening step, studies were also excluded through an abstract assessment, followed by the full text if necessary. Articles were excluded for not being a full-length article and being duplicate study. Errata and commentary were also excluded. Results The search returned 181 records. After applying the inclusion criteria 19 articles were selected for the synthesis of this paper. The results section in this narrative review was organized in subtopics to obtain a more pleaded narration. The subtopics in order are: costs, workflow, 46 Human Milk Banks pasteurization and other decontamination methods, and fortification. Costs Hospital administrators argue the expense of parental DHM as an enteral feeding option. Edwards and Spatz reported that during one fiscal year(2), a large pediatric hospital spent U.S.$155,000 to purchase parental DHM from an HMBANA milk bank, while more than $18.4 million was spent on total parenteral nutrition in the neonatal intensive care unit (NICU)(2). A systematic review aimed at evaluating the cost of DHM, the cost of treating necrotizing enterocolitis (NEC), and the costeffectiveness of exclusive DHM versus formula milk feeding to reduce the shortterm health and treatment costs of NEC, concluding that it is likely that DHM provides short-term cost savings by reducing NEC incidence(3). A study by Trang et al. aimed to determine the cost-effectiveness of supplemental DHM versus pre-term formula for very low birth weight (VLBW) infants from a societal perspective to 18 months’ corrected age, concluded that in a high mothers milk use setting, total costs did not differ, although post-discharge costs were lower in the DHM group(4). Eight estimates of the cost of DHM were reported across seven studies (3). The authors noted that improvements in how the milk banking service was organized could reduce labor and material costs. HMBANA milk banks charge U.S $4.00 to U.S.$5.00 per ounce for parental DHM (2).Using a purchase cost of U.S.$4.50 per ounce and trophic feeds at a rate of 5 ml every 3 hours or 40 ml per day, the cost for 1 day of parental DHM would equal U.S.$6.00 per day for one infant (2). The start-up and maintenance of an HMB (...truncated)