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Vaddi VK, Mascarenhas D, Kirthana SB, Mundhra N, Nanavati R. A Quality Improvement Initiative to Increase the Milk Donation to the Human Milk Bank Post-Coronavirus Disease-19 Pandemic. Breastfeed Med 2023; 18:864-869. [PMID: 37733277 DOI: 10.1089/bfm.2023.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Background and Objective: Donor human milk (DHM) from the human milk bank (HMB) is the next best alterative in circumstances when mother's own milk is not available. There was a steep decline in the volume of DHM collected during the coronavirus disease-19 (COVID-19) pandemic due to various factors, while DHM demand increased. Hence, a quality improvement (QI) study was conducted to increase the volume of milk donation to HMB from postpandemic baseline of 300-400 to 1,000 mL/day over 8 weeks. Materials and Methods: Fish bone analysis was used to identify the potential barriers, and four Plan-Do-Study-Act (PDSA) cycles were conducted from January 2021 to March 2021 to address the key barriers. In the first PDSA cycle, training of health care providers was done. Sessions for educating mothers in the second PDSA cycle and individualized one-to-one counseling of mothers by a mother support group were done in the third PDSA cycle. The availability of breast pump was increased in the fourth PDSA cycle. Sustainability of the interventions was studied for 6 months and data were analyzed. Results: The average DHM collected per day at the end of each PDSA cycle was 900, 1,500, 1,000, and 1,100 mL. Although the sustenance phase was affected by the second COVID-19 wave, prompt identification of the issues and timely interventions prevented the donated volume from dropping to preintervention levels. Conclusion: QI initiatives customized for local settings can result in significant improvement in voluntary milk donation in HMB, which can result in more availability of DHM to premature babies.
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Affiliation(s)
- Vamsi Krishna Vaddi
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Dwayne Mascarenhas
- Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
| | - S B Kirthana
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nitu Mundhra
- Department of Neonatology, Wockhardt Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Jain S, Bansal A, Khurana S, Chawla D. Quality improvement initiative for a sustained increase in human milk donation during the hospital stay. BMJ Open Qual 2023; 12:e002133. [PMID: 37863506 PMCID: PMC10603414 DOI: 10.1136/bmjoq-2022-002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The demand for donors' human milk is much more than the availability of the same due to the myriad challenges faced during the collection process. METHODS Baseline milk volume donation done in a human milk bank facility located in tertiary care government institute in a low-middle income country was assessed. It was initially aimed to increase the absolute quantity of milk volume donation by 30% over a period of 6 months, which was subsequently continued following COVID-19 emergence (over another 12 months) along with a particular emphasis on the sustenance of milk donation activities. INTERVENTIONS Counselling of both the healthcare workers and stakeholders, standardising the timing of milk donation and other policies, equipment in proportion to demand and supply and addition of human resource were done as a multiprong approach to have sustained increase in human milk donation. RESULTS The median control line (MCL) showed a shift of 27.8%; from a baseline of 5032 mL to 6971 mL during intervention phase I comprising of five plan do study act cycles spread over a period of 6 months. During the sustenance phase I even though the monthly collection was non-uniform, there was a further 16% upward shift in MCL to 8122 mL. During the second intervention phase, each component of the Ishikawa diagram was worked on (people, policy, place, procedure) resulting in a more than 100% increase from sustenance phase I taking the MCL to 17 181 mL with an overall increase of 3.41 times from the baseline. CONCLUSION Dedicated counselling and constant motivation have been conventionally considered as the utmost measure to increase milk volume donation in milk bank. Our study highlights the need to introduce scheduled timings along with sufficient equipment and manpower to overcome the shortage of milk donation in human milk bank facilities.
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Sivanandan S, Bethou A, Jebakani S, Calevanane V, Pushkaralochanan D. A quality improvement project to improve voluntary milk donation in a human milk bank in South India. Med J Armed Forces India 2023; 79:565-571. [PMID: 37719911 PMCID: PMC10499859 DOI: 10.1016/j.mjafi.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022] Open
Abstract
Background Mother's milk is the ideal food for a neonate. When mother's milk is unavailable for any reason, pasteurised donor human milk (PDHM) is the next best option. This quality improvement (QI) project aimed at improving voluntary donation in a public human milk bank (HMB) in South India. Methods Between January 2018 and June 2019, the HMB received an average of 15 L of donor milk per month (0.5 L/day). Our aim was to increase voluntary donation by 50% from the baseline over a period of 8 months from July 2019 to March 2020 using QI methods. Two plan-do-study-act (PDSA) cycles were done during the intervention period (4 months). Interventions included the formation of micro teams in postnatal wards to promote exclusive breastfeeding and to liaison with the core QI team. We created a milk expression area in the postnatal ward, counseled postnatal mothers, and addressed supply chain issues like sterile pumping accessories. Results The average daily voluntary milk donation to HMB increased from 0.83 L/day in the baseline phase to 1.16 and 1.14 L per day in the intervention and postintervention phases, respectively. The mean (SD) monthly donated volumes increased from 28.2 (6.1) L to 34.1 (3.7) L; mean difference (95% CI) 5.9 (0.33-11.4); P = 0.03. The volume of PDHM disbursed from HMB increased from 26.6 (3.2) L/month to 32.2 (9.2) L/month, although not statistically significant (p = 0.15). The number of mothers donating milk did not increase during the study period. Conclusions A multipronged QI intervention effort focusing on exclusive breastfeeding improved voluntary milk donation in HMB bank. Multiple micro-teams and local networking facilitated the QI initiative.
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Affiliation(s)
- Sindhu Sivanandan
- Assistant Professor (Neonatology), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Adhisivam Bethou
- Additional Professor & Head (Neonatology), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Sylvia Jebakani
- Senior Nursing Officer (Neonatology), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Vijaya Calevanane
- Senior Nursing Officer (Neonatology), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Divya Pushkaralochanan
- Lactation Counselor (Neonatology), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Bhasin M, Nangia S, Kumar G, Parihar A, Goel S. 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. Int Breastfeed J 2022; 17:85. [PMID: 36517901 PMCID: PMC9748401 DOI: 10.1186/s13006-022-00525-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/03/2022] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Maheshwar Bhasin
- grid.415723.60000 0004 1767 727XVatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India
| | - Sushma Nangia
- grid.415723.60000 0004 1767 727XVatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India ,grid.415723.60000 0004 1767 727XDepartment of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India
| | - Gunjana Kumar
- grid.415723.60000 0004 1767 727XDepartment of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India
| | - Abha Parihar
- grid.415723.60000 0004 1767 727XVatsalya Maatri Amrit Kosh, National Comprehensive Lactation Management Centre, Lady Hardinge Medical College, Connaught Circle, New Delhi, India
| | - Srishti Goel
- grid.415723.60000 0004 1767 727XDepartment of Neonatology, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India
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Abstract
Objective: The WHO recommends that low birth weight infants receive donor human milk (DHM) when mother’s milk is not available. Systematic reviews have been published regarding clinical outcomes of infants receiving DHM, as well as the impact of pasteurisation on the composition of DHM; however, information about milk bank donors has not been systematically assessed. Design: We conducted a systematic scoping review of original research articles about milk bank donors published before August 2020. Setting: Globally. Participants: Donors to milk banks. Results: A total of twenty-eight studies were included across a variety of geographies: the USA (n 8), Brazil (n 7), Spain (n 4), India (n 2), and single studies in France, Norway, Poland, Italy, Taiwan, Korea and China. Study variables were grouped into six main categories: Donor Demographics (n 19), Clinical Characteristics (n 20), Donor Experiences (n 16), Donation Patterns (n 16), Lifestyle Characteristics (n 4) and Lactation/Breast-feeding History (n 8). Some demographic characteristics were commonly reported across regions, while other, including gender and race, were infrequently explored. Factors that might influence the composition of DHM, including birth timing (term or pre-term), milk type (colostrum, transition or mature) and maternal diet were not regularly studied. Other gaps in the literature included (1) donors’ motivations and barriers to donation, (2) lactation and breast-feeding history, including factors that influence donors to pump and amass surplus milk, and (3) donation patterns, including whether donors are also selling milk to corporations or sharing milk with peers. Conclusion: What is known about milk bank donors in different geographies is often limited to a single study, with heterogeneity in the variables reported.
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Affiliation(s)
- Penny Reimers
- 56394 Department of Child Health and Paediatrics, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Coutsoudis
- 56394 Department of Child Health and Paediatrics, University of KwaZulu-Natal, Durban, South Africa
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Ananthan A, Balasubramanian H, Rao S, Patole S. Response to comments by Prof Abrams and Prof Lucas on "Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis". Adv Nutr 2020; 11:1713-1715. [PMID: 33191433 PMCID: PMC7666968 DOI: 10.1093/advances/nmaa099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/25/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
| | | | - Shripada Rao
- Department of Neonatal Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Sanjay Patole
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia,Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
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Aneja S, Kumar P, Choudhary TS, Srivastava A, Chowdhury R, Taneja S, Bhandari N, Daniel A, Menon P, Chellani H, Bahl R, Bhan MK. Growth faltering in early infancy: highlights from a two-day scientific consultation. BMC Proc 2020; 14:12. [PMID: 32944069 PMCID: PMC7490870 DOI: 10.1186/s12919-020-00195-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
Faltering of growth in early life has been recognized as a public health challenge among Indian babies. A two-day consultation on growth faltering in early infancy was organized to examine the data and evidence on identification and management of early growth failure and to identify knowledge gaps and future areas of research. The consultation was supported by the Biotechnology Industry Research Assistance Council (BIRAC), the Indian Academy of Pediatrics (Nutrition Chapter), Vardhman Mahavir Medical College and Safdarjung Hospital, and the Society for Applied Studies. It brought together researchers, clinicians, policy makers and program managers.
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Affiliation(s)
- Satinder Aneja
- School of Medical Sciences and Research, Sharda University, Greater Noida, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children’s Hospital, New Delhi, India
| | - Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Akanksha Srivastava
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Abner Daniel
- Nutrition Section, UNICEF India Country Office, New Delhi, India
| | - Purnima Menon
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, New Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Maharaj Kishan Bhan
- National Science Professor, Indian Institute of Technology, New Delhi, India
- Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
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Sachdeva RC, Jain S, Mukherjee S, Singh J. Ensuring Exclusive Human Milk Diet for All Babies in COVID-19 Times. Indian Pediatr 2020; 57:730-733. [PMID: 32525496 PMCID: PMC7444185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
The coronavirus disease (COVID-19) pandemic has ramifications for the delivery of newborn nutrition and care services. World Health Organization recommends continuation of breastfeeding in these difficult times, with due precautions. If direct breastfeeding is not possible, milk expression should be explored. Pasteurized donor human milk from milk banks may be fed if mother's own milk is not available. To universalize access to human milk, the Indian government has proposed the establishment of comprehensive lactation management centers/milk banks, lactation management units, and lactation support units at all levels of the public health system. Due to COVID-19, these centers are encountering additional challenges cutting across interventions of rooming in, breastfeeding, milk expression, and provision of donor milk and kangaroo mother care. We discuss issues faced and alleviation measures taken by these centres in relation to provision of an exclusive human milk diet for infants during the pandemic.
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Affiliation(s)
- Ruchika Chugh Sachdeva
- Maternal, Newborn, Child Health and Nutrition, PATH, New Delhi, India. Correspondence to: Ruchika Chugh Sachdeva, Deputy Director, Maternal, Newborn, Child Health and Nutrition, PATH 15th Floor, Gopal Das Bhawan, Barakhamba Road New Delhi- 110001, India.
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Suchandra Mukherjee
- Department of Neonatology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Jai Singh
- Department of Neonatology, District Hospital Chittorgarh, Rajasthan, India
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Abstract
The coronavirus disease (COVID-19) pandemic has ramifications for the delivery of newborn nutrition and care services. World Health Organization recommends continuation of breastfeeding in these difficult times, with due precautions. If direct breastfeeding is not possible, milk expression should be explored. Pasteurized donor human milk from milk banks may be fed if mother’s own milk is not available. To universalize access to human milk, the Indian government has proposed the establishment of comprehensive lactation management centers/milk banks, lactation management units, and lactation support units at all levels of the public health system. Due to COVID-19, these centers are encountering additional challenges cutting across interventions of rooming in, breastfeeding, milk expression, and provision of donor milk and kangaroo mother care. We discuss issues faced and alleviation measures taken by these centres in relation to provision of an exclusive human milk diet for infants during the pandemic.
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Affiliation(s)
- Ruchika Chugh Sachdeva
- Maternal, Newborn, Child Health and Nutrition, PATH, New Delhi, India. Correspondence to: Ruchika Chugh Sachdeva, Deputy Director, Maternal, Newborn, Child Health and Nutrition, PATH 15th Floor, Gopal Das Bhawan, Barakhamba Road New Delhi- 110001, India.
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Suchandra Mukherjee
- Department of Neonatology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Jai Singh
- Department of Neonatology, District Hospital Chittorgarh, Rajasthan, India
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Abstract
Background: Donor human milk plays a vital part in the care of sick neonates. There is paucity of literature on the profile of human milk donors of low- and middle-income countries (LMICs). Materials and Methods: This retrospective observational study evaluated the demographic profile of 1,553 donors of a human milk bank of a tertiary care center from a LMIC over a period of 21 months. Results: The mean age of the donors was 21.6 ± 2.7 years. Around 63% of the donors were from the postnatal care wards and 53.3% had given birth to a premature infant. The total volume of human milk donated was 413 L and the mean volume of milk per donor was 268 ± 386 mL. The mean amount of milk donated by the neonatal intensive care unit (NICU) mothers was significantly higher when compared to that donated by the postnatal care ward mothers (p = 0.0001). Two-thirds (65.5%) of the donated milk was from mothers who gave birth to a preterm infant and 20.8% was from mothers of preterm neonates of <32 weeks of gestation. There was no statistical difference between the mean amount of milk donated by a mother who had delivered extremely preterm neonates when compared to those who had delivered very preterm neonates (p = 0.18). Conclusions: The predominant donors of a human milk bank from a LMIC are of a younger age group, are more likely to have delivered a premature or a low birth weight baby, and are mostly the ones whose neonates require NICU admission or from postnatal care wards.
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Affiliation(s)
- Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Maheshwar Bhasin
- Vatsalya Maatri Amrit Kosh, Comprehensive Lactation Management Centre, Lady Hardinge Medical College, New Delhi, India
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