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Perrin MT, Gutierrez Dos Santos B, Mansen K, Israel-Ballard K. Global neonatal care and access to human milk. J Pediatr (Rio J) 2022; 98:545-547. [PMID: 35908657 PMCID: PMC9617274 DOI: 10.1016/j.jped.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Maryanne T Perrin
- University of North Carolina Greensboro, Department of Nutrition, Greensboro, United States.
| | | | - Kimberly Mansen
- PATH; Maternal, Newborn and Child Health and Nutrition Program, Seattle, United States
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Kim TH, Chung SH, Kim JH, Ahn Y, Shin SM, Lee WR, Choi EK, Lee J, Shin HJ, Jung E, Heo JS, Lee JA, Lee SM, Bae SP, Song J, Kim CY, Yi DY. Survey on the Status of Breastfeeding in Korean Medical Institution Workers. J Korean Med Sci 2022; 37:e120. [PMID: 35437968 PMCID: PMC9015900 DOI: 10.3346/jkms.2022.37.e120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. METHODS A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. RESULTS Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month (P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month (P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals (P = 0.003). A difference was also noted between occupation categories (P = 0.019), but a more significant difference was found in the comparison between nurses and doctors (P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts (P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference (P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. CONCLUSION In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.
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Affiliation(s)
- Tae Hyeong Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
| | - Jun Hwan Kim
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Youngmin Ahn
- Department of Pediatrics, Jangs Hospital, Seoul, Korea
| | - Son Moon Shin
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
| | - Woo Ryoung Lee
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eui Kyung Choi
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Juyoung Lee
- Department of Pediatrics, Bucheon St. Mary's Hospital, The Catholic University College of Medicine, Bucheon, Korea
| | - Hye-Jung Shin
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Euiseok Jung
- Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin A Lee
- Department of Pediatrics, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Phil Bae
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jeonglyn Song
- Chung-Ang University Industry Academic Cooperation Foundation, Seoul, Korea
| | - Chae-Young Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dae Yong Yi
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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Sempio C, Wymore E, Palmer C, Bunik M, Henthorn TK, Christians U, Klawitter J. Detection of Cannabinoids by LC-MS-MS and ELISA in Breast Milk. J Anal Toxicol 2021; 45:686-692. [PMID: 33002141 DOI: 10.1093/jat/bkaa142] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/14/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Cannabis is the most commonly used drug of abuse in pregnancy and after delivery. However, little is known regarding the disposition of cannabinoids in breast milk, although delta-9-tetrahydrocannabinol (THC), the main psychoactive component, is highly lipophilic. Quantification of cannabinoids in breastmilk is essential for clinical monitoring and research studies and breastmilk banks mainly rely on enzyme-linked immunosorbent assay (ELISA) in terms of screening for cannabinoids. To support clinical studies on disposition of cannabinoids in breastmilk, we validated a high-performance liquid chromatography-tandem mass spectrometry (LC-MS-MS) assay for the simultaneous quantification of 12 cannabinoids and their metabolites in human breast milk. Said assay was based upon a simple one-step protein precipitation, online column extraction and detection in the positive multiple reaction monitoring mode. After successful validation, the assay was used to analyze 30 samples from a clinical research study that had tested negative using an ELISA kit that is commonly used by breastmilk banks. In human breast milk, depending on the analyte, the lower limits of quantification of the LC-MS-MS assay ranged from 0.39 to 7.81 ng/mL. Acceptance criteria for intra- and inter-batch accuracy (85-115%) and imprecision (<15%) were met for all compounds. Mean extraction efficiencies were above 60% for all analytes. Mean matrix effect ranged from -12.5% to 44.5% except of THC-glucuronide for which significant matrix effects were noted. No carry-over was detected. Although cannabinoid-negative based on the ELISA, all 30 samples tested positive for THC using LC-MS-MS (0.8-130 ng/mL) and several also for 11-hydroxy-THC (11-OH-THC), 11-nor-9-carboxy-THC (THCCOOH), cannabidiol (CBD) and cannabigerol (CBG). We validated a sensitive and specific assay for the quantification of 12 cannabinoids in human breastmilk that outperformed an ELISA commonly used by breastmilk banks.
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Affiliation(s)
- Cristina Sempio
- Department of Anesthesiology, University of Colorado, Aurora, CO, USA
| | - Erica Wymore
- Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Claire Palmer
- Division of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maya Bunik
- Division of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas K Henthorn
- Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA.,Division of Substance Dependence, Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - Uwe Christians
- Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,Division of Substance Dependence, Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - Jost Klawitter
- Department of Anesthesiology, University of Colorado, Aurora, CO, USA.,Division of Substance Dependence, Department of Psychiatry, University of Colorado, Aurora, CO, USA
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Wong RK, Pitino MA, Mahmood R, Zhu IY, Stone D, O'Connor DL, Unger S, Chan TCY. Predicting Protein and Fat Content in Human Donor Milk Using Machine Learning. J Nutr 2021; 151:2075-2083. [PMID: 33847342 DOI: 10.1093/jn/nxab069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Donor milk is the standard of care for hospitalized very low birth weight (VLBW) infants when mother's milk is unavailable; however, growth of donor milk-fed infants is frequently suboptimal. Variability in nutrient composition of donated milk complicates the production of a uniform pooled product and, subsequently, the provision of adequate nutrition to promote optimal growth and development of VLBW infants. We reasoned a machine learning approach to construct batches using characteristics of the milk donation might be an effective strategy in reducing the variability in donor milk product composition. OBJECTIVE The objective of this study was to identify whether machine learning models can accurately predict donor milk macronutrient content. We focused on predicting fat and protein, given their well-established importance in VLBW infant growth outcomes. METHODS Samples of donor milk, consisting of 272 individual donations and 61 pool samples, were collected from the Rogers Hixon Ontario Human Milk Bank and analyzed for macronutrient content. Four different machine learning models were constructed using independent variable groups associated with donations, donors, and donor-pumping practices. A baseline model was established using lactation stage and infant gestational status. Predictions were made for individual donations and resultant pools. RESULTS Machine learning models predicted protein of individual donations and pools with a mean absolute error (MAE) of 0.16 g/dL and 0.10 g/dL, respectively. Individual donation and pooled fat predictions had an MAE of 0.91 g/dL and 0.42 g/dL, respectively. At both the individual donation and pool levels, protein predictions were significantly more accurate than baseline, whereas fat predictions were competitive with baseline. CONCLUSIONS Machine learning models can provide accurate predictions of macronutrient content in donor milk. The macronutrient content of pooled milk had a lower prediction error, reinforcing the value of pooling practices. Future research should examine how macronutrient content predictions can be used to facilitate milk bank pooling strategies.
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Affiliation(s)
- Rachel K Wong
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Pitino
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rafid Mahmood
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Ian Yihang Zhu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Debbie Stone
- Rogers Hixon Ontario Human Milk Bank, Sinai Health, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Rogers Hixon Ontario Human Milk Bank, Sinai Health, Toronto, Ontario, Canada.,Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Rogers Hixon Ontario Human Milk Bank, Sinai Health, Toronto, Ontario, Canada.,Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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Chagwena DT, Mugariri F, Sithole B, Mataga SF, Danda R, Matsungo TM, Maponga CC. Acceptability of donor breastmilk banking among health workers: a cross-sectional survey in Zimbabwean urban settings. Int Breastfeed J 2020; 15:37. [PMID: 32393361 PMCID: PMC7216340 DOI: 10.1186/s13006-020-00283-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends that donor human milk is superior to artificial infant formula in situations where the baby cannot feed on the mother's breastmilk. The purpose of this study was to determine the acceptability of donor human milk banking among health workers in Zimbabwean urban settings. METHODS A cross sectional study was conducted among 535 health workers and 15 key informants. Three referral hospitals were purposively selected and systematic random sampling was used to select the health workers. The study was conducted between October 2017 and October 2018. RESULTS The concept of donor human milk banking was acceptable among health workers. One-third (31%) of the study participants reported that they would accept donor breastmilk for their children while 56% of them would encourage their clients to donate breastmilk. Acceptance of donor human milk banking was associated with a high level of knowledge on breastmilk banks (p = 0.009) and the study participants' health profession (p = 0.001). Clinical staff were more receptive to donor human milk banking compared to non-clinical health workers. Donor human milk banking was not associated with religion (p = 0.498) or marital status (p = 0.714). CONCLUSIONS The results showed that health workers and policy informers would accept the establishment of breastmilk banks subject to resource availability. Commitment to the establishment of breastmilk banks was moderately acceptable among opinion leaders responsible for spearheading health and nutrition policies.
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Affiliation(s)
- Dexter T. Chagwena
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Nutri@ctive Zimbabwe, 96 Golden Stairs Rd, Mt Pleasant, Harare, Zimbabwe
| | - Felistas Mugariri
- Institute of Food, Nutrition and Family Sciences, Mt Pleasant, Harare, Zimbabwe
| | - Bhekimpilo Sithole
- Nutri@ctive Zimbabwe, 96 Golden Stairs Rd, Mt Pleasant, Harare, Zimbabwe
| | | | - Ruvimbo Danda
- UNICEF, 6 Fairbridge Avenue, Belgravia, Harare, Zimbabwe
| | | | - Charles C. Maponga
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Fogliano RRF, Bohomol E, Schveitzer MC, Coca KP, Abrão ACFDV. Quality management in Human Milk Banks: a scope review. Rev Bras Enferm 2020. [DOI: 10.1590/0034-7167-2019-0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Doshmangir L, Naghshi M, Khabiri R. Factors Influencing Donations to Human Milk Bank: A Systematic Review of Facilitators and Barriers. Breastfeed Med 2019; 14:298-306. [PMID: 30896254 DOI: 10.1089/bfm.2019.0002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Mother's own milk has long been accepted as the best source of nutrition for the newborn. In those cases where mother's milk is not available, the best choice is the human milk provided by selected donors. Human milk banks are the most institutionalized method of milk sharing and play a vital role for neonates that cannot be breastfed. This study aims at systematically reviewing factors influencing donation to human milk banks. Materials and Methods: A systematic review of the literature was performed on authentic electronic resources, including PubMed, Scopus, Embase, ScienceDirect, and Web of Science with no time limitation. To increase the sensitivity and to find additional studies for systematic review, the reference list of the published studies was examined as well. Data extraction and quality appraisal were carried out by two independent reviewers. The study was qualitatively summarized to generate descriptive and explanatory themes that emerged from the literature. Results: From a total of 1,157 articles, 31 met the inclusion criteria in which 64 factors are extracted. From these, 26 factors act as barriers and 38 factors act as facilitators of milk donation. Having excess milk, altruism, and helping other babies are found to be the most important facilitators of milk donation, while the most important barriers are religious and cultural concerns. Conclusion: Developing practical strategies to attract milk donors are crucial for successfully establishing human milk banks. These include providing reliable information regarding the milk bank goals and functions and developing breastfeeding polices with regard to differences in countries' contexts and trying to resolve any uncertainties regarding milk donation, especially those arising for religious concerns.
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Affiliation(s)
- Leila Doshmangir
- 1 Department of Health Services Management, Tabriz Health Services Management Research Centre, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,2 Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Naghshi
- 3 Department of Knowledge Translation, National Public Health Management Center (NPMC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roghayeh Khabiri
- 4 Department of Health Management, Tabriz Health Services Management Research Center, Health Management and safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Leonard A, Hittson Boal L, Pary P, Mo YD, Jacquot C, Luban NL, Darbari DS, Webb J. Identification of red blood cell antibodies in maternal breast milk implicated in prolonged hemolytic disease of the fetus and newborn. Transfusion 2019; 59:1183-1189. [PMID: 30720868 DOI: 10.1111/trf.15154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 11/10/2018] [Accepted: 12/12/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Alloantibodies against more than 50 non-ABO blood group antigens have been implicated in hemolytic disease of the fetus and newborn (HDFN) and are expected to wane within weeks after delivery. Persistent anemia leads to the hypothesis of continued exposure to red blood cell (RBC) alloantibodies via breast milk, which has been shown in a murine model and suggested in rare case reports. CASE REPORT We report three cases of prolonged HDFN in two neonates with anti-D HDFN and one with anti-Jka HDFN. Patient 1 demonstrated 4+ anti-D serologic testing beyond 2 months; therefore, antibody testing was performed on maternal breast milk. METHODS Maternal serum samples were tested for the presence of unexpected antibodies using standard Ortho gel card and 37 °C 60 minutes with anti-human globulin (AHG) tube saline methods. Antibody titrations were performed using the standard 37 °C 60 minutes to AHG tube saline method. Fresh breast milk samples were tested using the standard 37 °C 60 minutes to AHG tube saline method for both unexpected antibodies and titration study. Fresh breast milk from an O-positive, antibody-negative donor was used as control for any reactivity that may have been due to milk solids or proteins alone. RESULTS Using a known methodology applied in a novel way to test breast milk for RBC alloantibodies, antibodies against fetal RBCs were identified in the maternal breast milk of three patients. CONCLUSION Maternal RBC alloantibodies are present in breast milk and may be clinically significant in patients with prolonged recovery from HDFN.
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Affiliation(s)
- Alexis Leonard
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | - Lauren Hittson Boal
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | - Philippe Pary
- Divisions of Hematology and Laboratory Medicine and Pathology, Children's National Health System, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Y Delores Mo
- Divisions of Hematology and Laboratory Medicine and Pathology, Children's National Health System, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Cyril Jacquot
- Divisions of Hematology and Laboratory Medicine and Pathology, Children's National Health System, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Naomi L Luban
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
- Divisions of Hematology and Laboratory Medicine and Pathology, Children's National Health System, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Deepika S Darbari
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
| | - Jennifer Webb
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, District of Columbia
- Divisions of Hematology and Laboratory Medicine and Pathology, Children's National Health System, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Abstract
BACKGROUND Human milk banks (HMB) have been established for over 100 years in North America and Europe. This study aimed to describe and summarize the operation and characteristics of the HMBs in mainland China since the first nonprofit HMB operated in 2013. METHODS Operation of HMB in mainland China is based on the standards and guidelines of the Human Milk Banking Association of North America and some countries in Europe and was modified to meet the needs and circumstances in China such as donation only in the local HMB by medical staff. We reviewed the descriptive data of these 14 HMBs and the clinical characteristics of recipients, the eligible milk donors and the donor milk retrospectively. RESULTS In mainland China, from March 2013 to December 2016, 14 nonprofit HMBs were developed and operational in public hospitals except one and located in the south, east, north and northwest of mainland China. In total, 2680 eligible donors donated 4608.2 L of breast milk. The mean age of these donors was 29.4 years with 60.6% receiving college education and 90.6% term delivery. A total of 4678 recipients including preterm infants (n = 2990, 63.9%), feeding intolerance (n = 711, 15.2%), maternal illness (n = 345, 7.4%), serious infection (n = 314, 6.7%), necrotising enterocolitis (n = 244, 5.2%), post-surgery (n = 38, 0.8%) and others (n = 36, 0.8%). The rate of discarded raw milk was only 4.4% because of hepatitis B and C or cytomegalovirus positivity. CONCLUSIONS HMB has been developing rapidly in mainland China. Donor human milk was used not only for preterm infants but also for other ill children. But the sustainability of milk banking needs proper management and more financial support by relative health authorities and the government.
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Costa S, Maggio L, Alighieri G, Barone G, Cota F, Vento G. Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial. Ital J Pediatr 2018; 44:96. [PMID: 30115086 PMCID: PMC6097280 DOI: 10.1186/s13052-018-0532-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Human milk (HM) is the best feeding for premature infants. When own mother’s milk (OMM) is insufficient or unavailable, pasteurized donor human milk (PDHM) and preterm formula (PF) are the alternative nutritional sources, but the benefits of donor milk over formula are not defined. This study aimed to assess whether, in the absence of OMM, the PF could guarantee a feeding tolerance not inferior to that seen with the use of PDHM during the first two weeks of life of very preterm infants. Methods Infants with gestational age (GA) of ≤32 weeks who started enteral feeding within the first 7 days of life were randomized to receive PDHM or PF as a supplement to the OMM insufficient or unavailable. The primary outcome was the day of life when full enteral feeding (FEF) of 150 mL/Kg/d was achieved. Results Seventy infants were randomized, 35 in the PF group (GA 30.2 ± 1.7 weeks; BW 1342 ± 275 g), 35 in the PDHM group (GA 30 ± 1.9 weeks; BW 1365 ± 332 g). The time to achieve FEF was the same for infants fed with PF and for infants fed with PDHM (12.3 ± 7.0 days vs 12.8 ± 6.5). Conclusions This trial shows that PF could be a valid alternative for the early feeding of very preterm infants when OMM is insufficient or unavailable. Trial registration UMIN000013922. Date of formal registration: December 31, 2014.
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Affiliation(s)
- Simonetta Costa
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Luca Maggio
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giovanni Alighieri
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giovanni Barone
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesco Cota
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health, Obstetric and Neonatology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
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Flaherman VJ, Maisels MJ, Noble L, Brent N, Bunik M, Harrel C, Lawrence RA, Marinelli KA, Reece-Stremtan S, Rosen-Carole C, Seo T, St. Fleur R, Young M. ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017. Breastfeed Med 2017; 12:250-257. [PMID: 29624434 DOI: 10.1089/bfm.2017.29042.vjf] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Valerie J Flaherman
- 1 Department of Pediatrics, School of Medicine, University of California , San Francisco, California
| | - M Jeffrey Maisels
- 2 Department of Pediatrics, William Beaumont School of Medicine, Oakland University , Royal Oak, Michigan
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12
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DeMarchis A, Israel-Ballard K, Mansen KA, Engmann C. Establishing an integrated human milk banking approach to strengthen newborn care. J Perinatol 2017; 37:469-474. [PMID: 27831549 PMCID: PMC5415705 DOI: 10.1038/jp.2016.198] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
Abstract
The provision of donor human milk can significantly reduce morbidity and mortality among vulnerable infants and is recommended by the World Health Organization as the next best option when a mother's own milk is unavailable. Regulated human milk banks can meet this need, however, scale-up has been hindered by the absence of an appropriate model for resource-limited settings and a lack of policy support for human milk banks and for the operational procedures supporting them. To reduce infant mortality, human milk banking systems need to be scaled up and integrated with other components of newborn care. This article draws on current guidelines and best practices from human milk banks to offer a compilation of universal requirements that provide a foundation for an integrated model of newborn care that is appropriate for low- and high-resource settings alike.
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Affiliation(s)
- A DeMarchis
- Maternal, Newborn, Child Health and Nutrition Program PATH, Seattle, WA, USA
- Nutritional Sciences Program, University of Washington, Seattle, WA, USA
| | - K Israel-Ballard
- Maternal, Newborn, Child Health and Nutrition Program PATH, Seattle, WA, USA
| | - Kimberly Amundson Mansen
- Maternal, Newborn, Child Health and Nutrition Program PATH, Seattle, WA, USA
- Seattle Children's Hospital, Seattle, WA, USA
| | - C Engmann
- Maternal, Newborn, Child Health and Nutrition Program PATH, Seattle, WA, USA
- Seattle Children's Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Global Health University of Washington, Seattle, WA, USA
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13
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Jang HL, Cho JY, Kim MJ, Kim EJ, Park EY, Park SA, Kim IY, Choi YS, Bae CW, Chung SH. The Experience of Human Milk Banking for 8 Years: Korean Perspective. J Korean Med Sci 2016; 31:1775-1783. [PMID: 27709856 PMCID: PMC5056210 DOI: 10.3346/jkms.2016.31.11.1775] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022] Open
Abstract
Human milk banks are a solution for mothers who cannot supply their own breast milk to their sick or hospitalized infants; premature infants, in particular, are unable to receive a full volume of breast milk for numerous reasons. As of December 2015, there was only one milk bank in a university hospital in Korea. We reviewed the basic characteristics of donors and recipients, and the amounts and contamination of breast milk donated at the Human Milk Bank in Kyung Hee University Hospital at Gangdong in Korea from 2008 to 2015. The donor pool consisted of 463 first-time donors and 452 repeat donors who made 1,724 donations. A total of 10,820 L of breast milk was collected, and 9,541.6 L were processed. Detectable bacteria grew in 12.6% after pasteurization and 52.5% had cytomegalovirus DNA before pasteurization in donated milk. There were 836 infant and 25 adult recipients; among new infant recipients, 48.5% were preterm; the groups received 8,009 and 165.7 L of donor milk, respectively. There was an increase in the percentage of preterm infants among new infant recipients in 2015 (93.1%) compared to 2008 (8.5%). Based on the number of premature infants in Korea, the number of potential recipients is not likely to diminish anytime soon, despite efforts to improve the breastfeeding rate. Sustainability and quality improvement of the milk bank need long-term financial support by health authorities and a nationwide network similar to blood banking will further contribute to the progress of milk banking.
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Affiliation(s)
- Hye Lim Jang
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Yoon Cho
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Jeong Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Young Park
- Human Breast Milk Bank, Mother & Infant Care Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Ae Park
- Human Breast Milk Bank, Mother & Infant Care Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - In Young Kim
- Human Breast Milk Bank, Mother & Infant Care Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chong Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
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14
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Khalil A, Buffin R, Sanlaville D, Picaud JC. Milk kinship is not an obstacle to using donor human milk to feed preterm infants in Muslim countries. Acta Paediatr 2016; 105:462-7. [PMID: 26659819 DOI: 10.1111/apa.13308] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/06/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED The development of human milk banks in Muslim countries is challenging because of the tradition of milk kinship. In other countries, this tradition imposes restrictions on Muslim mothers with regard to donating their milk or receiving donor milk for their preterm baby. However, Muslim law does allow the use of donated human milk under certain conditions, for example if it comes from a single known donor or is pooled from the milk of at least three donors. CONCLUSION Muslim parents need to be made aware that human milk banks can be used for preterm babies if strict conditions are met.
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Affiliation(s)
- Aliaa Khalil
- Lactarium Régional Rhône-Alpes; Hôpital de la croix rousse; Lyon France
- Service de Néonatologie; Hôpital de la croix rousse; Lyon France
- Senghor University; Alexandrie Egypt
| | - Rachel Buffin
- Lactarium Régional Rhône-Alpes; Hôpital de la croix rousse; Lyon France
- Service de Néonatologie; Hôpital de la croix rousse; Lyon France
| | - Damien Sanlaville
- Service de Génétique; Hôpital Femme-Mère-Enfant; Bron France
- Faculté de Médecine Lyon-Sud Charles Mérieux; Université Claude Bernard Lyon 1; Pierre Bénite France
| | - Jean-Charles Picaud
- Lactarium Régional Rhône-Alpes; Hôpital de la croix rousse; Lyon France
- Service de Néonatologie; Hôpital de la croix rousse; Lyon France
- Faculté de Médecine Lyon-Sud Charles Mérieux; Université Claude Bernard Lyon 1; Pierre Bénite France
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15
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Kantorowska A, Wei JC, Cohen RS, Lawrence RA, Gould JB, Lee HC. Impact of Donor Milk Availability on Breast Milk Use and Necrotizing Enterocolitis Rates. Pediatrics 2016; 137:e20153123. [PMID: 26908696 PMCID: PMC4771129 DOI: 10.1542/peds.2015-3123] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To examine the availability of donor human milk (DHM) in a population-based cohort and assess whether the availability of DHM was associated with rates of breast milk feeding at NICU discharge and rates of necrotizing enterocolitis (NEC). METHODS Individual patient clinical data for very low birth weight infants from the California Perinatal Quality Care Collaborative were linked to hospital-level data on DHM availability from the Mothers' Milk Bank of San José for 2007 to 2013. Trends of DHM availability were examined by level of NICU care. Hospitals that transitioned from not having DHM to having DHM availability during the study period were examined to assess changes in rates of breast milk feeding at NICU discharge and NEC. RESULTS The availability of DHM increased from 27 to 55 hospitals during the study period. The availability increased for all levels of care including regional, community, and intermediate NICUs, with the highest increase occurring in regional NICUs. By 2013, 81.3% of premature infants cared for in regional NICUs had access to DHM. Of the 22 hospitals that had a clear transition to having availability of DHM, there was a 10% increase in breast milk feeding at NICU discharge and a concomitant 2.6% decrease in NEC rates. CONCLUSIONS The availability of DHM has increased over time and has been associated with positive changes including increased breast milk feeding at NICU discharge and decrease in NEC rates.
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Affiliation(s)
- Agata Kantorowska
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Julia C. Wei
- Berkeley School of Public Health, University of California, Berkeley, California
| | - Ronald S. Cohen
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and
| | | | - Jeffrey B. Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and,California Perinatal Quality Care Collaborative, Stanford, California
| | - Henry C. Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and,California Perinatal Quality Care Collaborative, Stanford, California
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16
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Assad M, Elliott MJ, Abraham JH. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet. J Perinatol 2016; 36:216-20. [PMID: 26562370 DOI: 10.1038/jp.2015.168] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/08/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Human milk is the best form of nutrition for preterm infants and has been associated with a lower incidence of necrotizing enterocolitis (NEC). Infants that develop NEC have a higher incidence of feeding intolerance and longer hospitalizations. The combination of a donor milk bank and donor milk-derived fortifier has changed feeding practices in neonatal intensive care units (NICU). The purpose of this study is to assess the benefits and cost of an exclusive human milk (EHM) diet in very low birth weight (VLBW) infants in a community level III NICU. STUDY DESIGN This is a retrospective study including preterm infants ⩽28 weeks and/or VLBW (⩽1500 g) who were enrolled from March 2009 until March 2014. Infants were grouped as follows: group H (entirely human milk based, born March 2012 to 2014), group B (bovine-based fortifier and maternal milk, born March 2009 to 2012), group M (mixed combination of maternal milk, bovine-based fortifier and formula, born March 2009 to 2012) and group F (formula fed infants, born March 2009 to 2012). Baseline characteristics among the four groups were similar. RESULT The study included 293 infants between gestational ages 23 to 34 weeks and birth weights between 490 and 1700 g. Feeding intolerance occurred less often (P<0.0001), number of days to full feeds was lower (P<0.001), incidence of NEC was lower (P<0.011), and total hospitalization costs were lower by up to $106,968 per infant (P<0.004) in those fed an EHM diet compared with the other groups. Average weight gain per day was similar among the four groups (18.5 to 20.6 g per day). CONCLUSIONS Implementing an EHM diet in our VLBW infants has led to a significant decrease in the incidence of NEC. Other benefits of this diet include: decreased feeding intolerance, shorter time to full feeds, shorter length of stay, and lower hospital and physician charges for extremely premature and VLBW infants.
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Affiliation(s)
- M Assad
- Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
| | - M J Elliott
- Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA.,Pediatrix Medical Group of Maryland, The Herman & Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
| | - J H Abraham
- Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA
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De Nisi G, Moro GE, Arslanoglu S, Ambruzzi AM, Biasini A, Profeti C, Tonetto P, Bertino E. Survey of Italian human milk banks. J Hum Lact 2015; 31:294-300. [PMID: 25722356 DOI: 10.1177/0890334415573502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/19/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND At present, the Italian Association of Donor Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato, AIBLUD) consists of 31 milk banks, whose management is based on Italian Guidelines. In 2013, AIBLUD performed a systematic survey to collect data on the activities of banks operating in Italy in the years previous to this date. OBJECTIVE The purpose of this survey was to evaluate the operational procedures of Italian Human Milk Banks in order to identify both areas of strength and room for improvement. METHODS A questionnaire was utilized to obtain national data from the 28 banks active in the year 2012 in order to evaluate the number of donors, volume of human milk collected, and other information relating to the period 2007 to 2012. RESULTS In all, 89% of the banks (25/28) responded to the survey. Data received primarily concerned the number of donors, volume of milk collected, and average amount of milk from each donor in the period 2007 to 2012. It was evident that in 2012 human milk banks collected a higher volume of milk than in 2007. Further, the average amount of milk from each donor was higher. Most of the milk banks were following the Italian Guidelines for traceability, control of donors, bacteriological checks, method of pasteurization, storage, thawing, type of containers, and utilization of the Hazard Analysis and Critical Control Points system. CONCLUSION This survey identified both areas of strength and room for improvement in the Italian human milk banks.
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Affiliation(s)
- Giuseppe De Nisi
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy
| | - Guido E Moro
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy
| | - Sertac Arslanoglu
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy Department of Neonatology, Dr Behcet Uz Children's Hospital, Izmir, Turkey
| | - Amalia M Ambruzzi
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy
| | - Augusto Biasini
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy Pediatric and Neonatal Intensive Care Units, Bufalini Hospital, Cesena, Italy
| | - Claudio Profeti
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy Neonatal Intensive Care Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Paola Tonetto
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Enrico Bertino
- Board of Directors, AIBLUD (Italian Association of Donor Human Milk Banks), Milan, Italy Neonatal Intensive Care Unit, University of Turin, Turin, Italy
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Salmon L. Food security for infants and young children: an opportunity for breastfeeding policy? Int Breastfeed J 2015; 10:7. [PMID: 25750657 PMCID: PMC4352266 DOI: 10.1186/s13006-015-0029-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/05/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Increased global demand for imported breast milk substitutes (infant formula, follow-on formula and toddler milks) in Asia, particularly China, and food safety recalls have led to shortages of these products in high income countries. At the same time, commodification and trade of expressed breast milk have fuelled debate about its regulation, cost and distribution. In many economies suboptimal rates of breastfeeding continue to be perpetuated, at least partially, because of a failure to recognise the time, labour and opportunity costs of breast milk production. To date, these issues have not figured prominently in discussions of food security. Policy responses have been piecemeal and reveal conflicts between promotion and protection of breastfeeding and a deregulated trade environment that facilitates the marketing and consumption of breast milk substitutes. DISCUSSION The elements of food security are the availability, accessibility, utilization and stability of supply of nutritionally appropriate and acceptable quantities of food. These concepts have been applied to food sources for infants and young children: breastfeeding, shared breast milk and breast milk substitutes, in accordance with World Health Organization (WHO)/United Nations Children's Fund (UNICEF) guidelines on infant feeding. A preliminary analysis indicates that a food security framework may be used to respond appropriately to the human rights, ethical, economic and environmental sustainability issues that affect the supply and affordability of different infant foods. SUMMARY Food security for infants and young children is not possible without high rates of breastfeeding. Existing international and national instruments to protect, promote and support breastfeeding have not been implemented on a wide scale globally. These instruments need review to take into account the emerging trade environment that includes use of the internet, breast milk markets and globalised supply chains for breast milk substitutes. New approaches are required to handle the long-standing policy conflicts that surround infant and young child feeding. Placing breastfeeding in a food security framework may achieve the political attention and policy co-ordination required to accelerate breastfeeding rates in a range of economies.
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Affiliation(s)
- Libby Salmon
- Australian Centre for Economic Research on Health, Research School of Population Health, The Australian National University, Building #62, Corner of Mills & Eggleston Roads, Canberra, ACT 0200 Australia
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