Abstract
This month's issue of Breastfeeding Medicine highlights a variety of articles relating to the use of donor milk. The issues addressed range from the report of Schreiner regarding standards and methodology of assessing the potential of microbiological contamination of donor milk to the results of different rates of cooling of milk after standard pasteurization on melatonin levels. Most interesting is the report of Hendricks-Munoz and colleagues describing their program designed to counteract the seemingly paradoxical phenomenon of the decrease in mother's own milk (MOM) feeding at discharge from the newborn intensive care units (NICU) after the infants had received door milk during their NICU hospitalizations.
Previous reports have documented the contrary results, wherein Corallo reported that the use of donor milk led to an increased rate of MOM feeding at discharge, 1 while Parker reported the opposite, 2 that is, a decrease in MOM feeding at discharge. 2 Esquerra et al. reported 3 that the impact of donor milk use in the NICUs on ultimate MOM feeding varied, with the risk for MOM discontinuation being significantly associated with maternal young age, multiparity, and non-Hispanic Black race/ethnicity, Thus, Schreiner description of a program designed to minimize this risk is most welcome and should serve as model for the NICU staff to be alert as to the potential negative side effect of a donor milk program and how to counteract this phenomenon.
The vital availability of an established donor milk bank to respond to unexpected demands was recently discussed in real-time detail by Zimmerman in a presentation to the recent meeting of the Academy of Breastfeeding Medicine. 4 The October 7th terrorist attack on the civilian population of the Israeli communities abutting Gaza created a reality of three new populations of infants who were suddenly cut off from their nurturing mothers: (1) mothers who were either killed and severely injured in the attack; (2) mothers who were taken hostage to Gaza by the Hamas terrorists; and (3) infants whose mothers were called up for active army duty and thus unavailable to continue to nurse their infants. The policy of Israel's National Milk Bank policy until this emergency was to provide donor milk for high-risk premature infants and for infants with rare medical conditions that required an exclusive human milk diet. As a result of the October terrorist attack and the military response of Israel, the policy of the Milk Bank was changed to provide milk in addition to any infant, whose mother was in any of the three noted above groups. No less important, the Israel Ministry of Heath decided to provide financial support for this expanded donor milk program. In parallel, the Israeli public responded by significantly increasing the amount of milk donated by otherwise healthy mothers.
A comprehensive review of the barriers that exist worldwide for the establishment and proper functioning of milk banks was recently provided by Mathias et al. 5 In their comprehensive and detailed study, they categorized the barriers and facilitators for donating and accepting breast milk under six themes: individual, family, community, workplace, health system, and policy-related. Individual barrier factors as expected “were time requirements for accepting donor milk, personal dislike of the process, lack of knowledge, insufficient milk, negative opinions, and lack of information.” “Family stigma, negative rumors, less educated family members, and illness of a family member were identified as family-related barriers while community-related barriers included cultural or religious unacceptable practices, societal taboos, and distance to milk banks.” The major barriers identified in relation to the health system “were lack of practical and psychological support, lack of information, storing and transportation issues, and logistical challenges of creating a milk lab.” Policy-related barriers identified “included the need for hygiene requirements, donation costs, and lack of standardized guidelines.”
This detailed summary of the potential challenges of setting up and running a successful milk bank can surely serve as a blueprint for health planners worldwide and as guide to appropriately adapt their plans to meet the uniqueness of different locations and situations.