Sobre bancos de leche humana y lactancia materna

Quality management in Human Milk Banks: a scope review

ABSTRACT Objectives: to identify the main quality management interventions used by professionals working at Human Milk Banks. Methods: a scope review conducted at PubMed, VHL, Scopus, SciELO, CAPES thesis and Google Scholar databases. Primary studies were included that address quality improvement strategies to improve Milk Bank processes in Portuguese, English and Spanish. Results: search totaled 192 scientific studies, 17 of which met the objective of the study and inclusion criteria. The main quality management interventions used in the Human Milk Bank addressed tools for continuous improvement. Six were aimed at improving processes, one to prevent errors and failures and two to achieve continuous monitoring. Final Considerations: the tools used by professionals working in Human Milk Banks have demonstrated effectiveness in managing the quality of services.

[Satellite center of human milk: Analysis of cost reduction]

INTRODUCTION

Donor milk is the second best alternative for a newborn after the mother's own milk, especially when the baby is a premature or a sick child since this milk has the advantage of protecting against necrotizing enterocolitis. There are currently 13 milk banks in Spain, however this is not sufficient to supply all Spanish neonatal units with donor milk. In order to bring donor milk to the babies in Neonatal Unit of the Regional University Hospital of Malaga, a Satellite Centre (CS) was created in 2012, depending on the Milk Bank of Virgen de las Nieves Hospital in Granada.

AIM

Assessing the efficiency of a SC compared to an independent milk bank.

METHOD

A study of cost minimization is used for the analysis. The cost of the implementation of the SC is calculated and compared to the cost of the implementation of the Milk Bank of Virgen de las Nieves of Granada. Additionally, the maintenance cost per year of the 2 models is compared, taking into account the running phase from June, 2012 through August 2015 in the SC.

RESULTS

A SC implies savings of 88,852 Euro in equipment, and 24,572 Euro per year in maintenance compared to an independent milk bank.

CONCLUSIONS

The efficiency of the SC is due to a better use of resources. A distribution network model of donor human milk, consisting of milk banks and SC, makes it possible to equally supply human milk to premature infants with a reduced cost.

Maternal and neonatal hair and breast milk in the assessment of perinatal exposure to drugs of abuse

Perinatal exposure to one or more drugs of abuse can affect the neonate temporarily or permanently. In addition to meconium, the evaluation of perinatal exposure to drugs of abuse has been achieved by testing biological matrices coming from the newborn (neonatal hair) and from the pregnant or nursing mother (maternal hair and breast milk). These matrices have the advantage of noninvasive collection and account for a sizable time window of active and passive exposure. Sensitive and specific analytical methods are required to determine minute amounts of drugs of abuse and metabolites in these matrices. The present manuscript reviews the newest analytical methods developed to detect drugs of abuse as well as ethanol biomarkers in maternal and neonatal hair and breast milk.

[Study of the effects of the implementation of a human milk donor bank in preterm newborns in Aragon]

INTRODUCTION

Numerous obstacles may prevent a premature or sick neonate receiving their mother's milk. In these cases, pediatric scientific societies recommend feeding with donor human milk. In this article, it is explained what a milk bank is, how it works, the donors' selection method, and the benefits. We also describe the current situation in Aragon (Spain) is also described.

MATERIAL AND METHODS

A retrospective and descriptive study was conducted on the perinatal sample characteristics, as well as an analytical observational study, comparing two sample groups: pre- and post-human milk bank. Finally, differences in the post-bank stage between those patients fed with own-mother's or donor human milk were determined.

RESULTS

The study included a total of 234 patients: 104 females and 130 males. Two groups: pre and post-bank, with 152 and 82 patients, respectively, which had similar characteristics at birth; length and head circumference were significantly higher in the post-bank group and a lower rate of necrotizing enterocolitis was also found. No statistically significant differences were found in other variables between subgroups fed with own-mother's milk and donor human milk.

DISCUSSION

The establishment of the human milk donor bank has a beneficial effect, as it reduces neonatal morbidity in cases of necrotizing enterocolitis. Human milk feeding could be a protective factor against neonatal sepsis due to improve immunity.

CONCLUSIONS

The incidence of necrotizing enterocolitis is lower after the establishment of the milk bank. Studies with more patients may demonstrate differences in other variables.

Donor milk volume and characteristics of donors and their children

BACKGROUND

Little is known regarding the effect of the characteristics of donors and their children on the volume of donor milk delivered to a human milk bank (HMB).

AIMS

Our study aimed to determine the relationship between different social and demographic variables of donors and their infants with the volume of human milk delivered.

METHODS

We included donors accepted at the Hospital Doce de Octubre HMB from January 1st, 2009 until April 31st, 2013, and who had finished their donation. Data of social and demographic characteristics of the donors and their children, and the total volume of DHM given were obtained from our HMB database. Included variables were previous donors, donor age, number of children, place of residence, gestational age of the infant at birth, child's age at the start of the donation, hospital admission, and death of the infant. A linear regression model was used to study the relationship between independent variables that were significant in bivariate analysis and the volume of donated milk.

RESULTS

A total of 415 donations from 391 women were included. The median volume of milk delivered was 3.1l (IQR-interquartile range-1.3-8.3l). In the linear regression model, previous donors, smaller gestational age of children, and the start of donation at earlier stages of lactation were associated with a larger quantity of HMB donated (p≤0.001).

CONCLUSION

Previous donors, smaller gestational age of children, and the start of donation at earlier stages of lactation are associated with a larger quantity of milk donated to the HMB.