Using donor human milk to feed vulnerable term infants: a case series in KwaZulu Natal, South Africa

Unveiling the voices: Exploring perspectives and experiences of women, donors, recipient mothers and healthcare professionals in human milk donation: A systematic review of qualitative studies

OBJECTIVES

This study aims to examine and synthesise the views and experiences of women, donors, recipient mothers and healthcare professionals regarding human milk donation or sharing.

METHODS

The Joanna Briggs Institute (JBI) meta-aggregative approach to systematic reviews of qualitative studies was adopted. Six databases, MEDLINE, CINAHL, Embase, PsycINFO, Web of Science and Scopus were searched. English written qualitative studies from database inception to February 2024 were included. The JBI Critical Appraisal Checklist for Qualitative Research was used to appraise the collected research evidence.

RESULTS

A total of 629 papers were screened, and 41 studies were included in the review. Six key findings were synthesised. (i) Donors, recipients and their families all benefit from milk donation. (ii) Motivation to receive or donate breast milk. (iii) Awareness and participation are affected by formal vs. informal sharing, mothers' personal experiences and external factors. (iv) Concerns about disease transmission, jealousy, bonding and traits. (v) Challenges encountered by donors, recipient mothers, staff and milk banks (vi) Suggestions for promoting human milk donation.

DISCUSSION

Stakeholders of human milk donation, including donors, recipient mothers, healthcare professionals, and human milk bank representatives, face various physical, mental and practical challenges. Informal sharing complements formal donations and contributes to improved breastfeeding rates. Advocacy and education efforts are still needed to increase participation and safety levels. The major limitation of the study is the inadequate search on views of immediate family members.

"Go With the Flow": A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States

ABSTRACT

Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother-infant dyad.

Rural Nurses' Views on Breastmilk Banking in Limpopo Province, South Africa: A Qualitative Study

The development of breastmilk banks is being established among the African population, including in Limpopo Province. However, the views of nurses directly handling the donated breastmilk in the province remain unknown. This study was aimed at exploring and describing the views of nurses towards breastmilk banking in the Mankweng area, Limpopo Province. A qualitative, descriptive, and explorative study was undertaken at a tertiary hospital and a rural feeder clinic in the Mankweng area. Purposive sampling was employed to obtain participants for the interviews. One-on-one, semi-structured interviews were conducted to explore the views of these nurses. Data were analysed using Tesch’s open coding method, with the information obtained being grouped into different themes and sub-themes. Almost all nurses were willing to donate their breastmilk to the bank. However, receiving donated breastmilk for their own children seemed to be a challenge due to the safety of the donated breastmilk, uncertainty about the screening process, and cultural issues. Although donation of breastmilk appeared to be well supported by almost all the nurses, the use of donated breastmilk seemed to be not fully acceptable. Increased awareness about breastmilk donation and banking should be prioritised in the province.

Use of donor human milk in nonhospitalized infants: An infant growth study

When mother's own milk (MOM) is unavailable or insufficient, donor human milk (DHM) is recommended as the next best alternative for low birthweight infants. DHM use for healthy, term infants is increasing, but evidence for growth and tolerability is limited. This retrospective study evaluated growth in term infants in the community who received DHM from a UK milk bank. Mothers of infants receiving DHM between 2017 and 2019 were contacted (n = 49), and 31 (63.2%) agreed to participate. Fourteen infants received DHM as a supplement to other feeds (MOM and/or infant formula) and 17 were exclusively fed DHM where breastfeeding was impossible (range: 3–6 weeks). Growth was assessed by deriving z‐scores using the WHO standard for infant growth and compared with 200 exclusively breastfed infants. Multivariate regression analysis revealed no feeding method‐specific association between z‐score and age, nor between weight and age, suggesting that z‐scores and growth velocity were not affected by feeding exclusive MOM, supplemental DHM or exclusive DHM. DHM was well‐tolerated with no adverse events that led to early cessation. After receiving supplemental DHM group, 63% of infants whose mothers had no physical barrier to breastfeeding (5/8 infants) were exclusively breastfed. This novel study reports adequate growth outcomes of healthy nonhospitalized infants receiving DHM, either as the sole milk source or supplement. Prospective studies are needed to confirm whether DHM is a suitable feeding alternative for term infants in the community, optimal durations, as well as the impact of DHM availability on breastfeeding rates and maternal mental health.

DHM recipients were compared with the who infant growth standard (World Health Organization, 2020) by deriving z‐scores. The WHO Anthro Macro (World Health Organization, 2011 ) was used to calculate weight‐for‐age, length‐for‐age and head circumference‐for‐age z‐scores; z‐scores are the standard deviation of an infant's anthropometric measurements when compared with the WHO standard for infant growth and are gender and age specific.

Current Trends in Research on Human Milk Exchange for Infant Feeding

Breastfeeding is critical for the healthy growth and development of infants. A diverse range of infant-feeding methods are used around the world today. Many methods involve feeding infants with expressed human milk obtained through human milk exchange. Human milk exchange includes human milk banking, human milk sharing, and markets in which human milk may be purchased or sold by individuals or commercial entities. In this review, we examine peer-reviewed scholarly literature pertaining to human milk exchange in the social sciences and basic human milk sciences. We also examine current position and policy statements for human milk sharing. Our review highlights areas in need of future research. This review is a valuable resource for healthcare professionals and others who provide evidence-based care to families about infant feeding.