MANIKAKA TOPAWALA

INSTITUTE OF NURSING

COURSE: Midwifery & Obstetric Nursing

TOPIC: Assignment on Human Milk Banking

Submitted to:
Miss,Angelina Makwana,
Nursing tutor,
MTIN
Submitted by:
Ms.Srusti Patel-16BN036
Ms.Shivali Patel-16BN035
Ms.Priyanka Patel-16BN034
3rd year 6th sem
MTIN
Submitted on:
22nd September,2019

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 INDEX

Sr. No. Topic Pg. No.

1 Introduction 03
2 History 03
3 Donor 04
4 Recipient 05
5 Equipments 05
6 Indications 06
7 Contraindications/Limitations 06
8 Procedure 07
9 Guidelines 10
10 Benefits 11
11 Care 11

12 Bibliography 13

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 HUMAN MILK BANKING
Introduction:-
 A human milk bank or breast milk bank is a service which collects, screens, processes,
and dispenses by prescription human milk donated by nursing mothers who are not
biologically related to the recipient infant. The optimum nutrition for newborn infants is
breastfeeding, if possible, for the first year. Human milk banks offer a solution to the
mothers that cannot supply their own breast milk to their child, for reasons such as a
baby being at risk of getting diseases and infections from a mother with certain
diseases, or when a child is hospitalized at birth due to very low birth weight (and thus
at risk for conditions such as necrotizing enterocolitis), and the mother cannot provide
her own milk during the extended stay for reasons such as living far from the hospital.

 Human milk banks had an increase in the amount of milk collected in 2012 compared to
2007, in addition the amount of milk donated by each donor had also increased. Mothers'
Milk Bank (MMB) says, this service provides mothers with an alternative to infant
formula and allows the mother to give their newborn the nutrition it needs for healthy
growth. The International Milk Banking Initiative (IMBI), was founded at the
International HMBANA Congress in 2005. It lists 33 countries with milk bank
programs. The World Health Organization(WHO) states that the first alternative to a
biological mother not being able to breast feed is the use of human milk from other
sources.

 The primary and by far the largest group of consumers of human breast milk are
premature babies. Infants with gastrointestinal disorders or metabolic disorders may
also consume this form of milk as well. Human breast milk acts as a substitute, instead of
formula, when a mother cannot provide her own milk. Human breast milk can also be fed
to toddlers and children with medical conditions that include but are not limited to
chemotherapy for cancer and growth failure while on formula.

History:-

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 Donating breast milk can be traced back to the practice of wet nursing. The first record
of regulations regarding the sharing of breastmilk are found in the Babylonian Code of
Hammurabi (1800 BC). These regulations were motivated by the long-held belief that
infants inherit the nurse's traits through their breast milk. By the 11th century European
culture considered breastfeeding indecent, which led wet nursing to become common
practice among royalty and aristocracy of Europe. The practice of wet nursing declined
by the 19th century due to concerns regarding unhealthy lifestyles among
nurses. Consequently, the medical community began researching the effects of
alternative nutrition on neonates. Theodor Escherich of the University of Vienna
conducted studies from 1902 to 1911 investigating different sources of nutrition and
their effect on neonates. His studies demonstrated that breastfed neonate's intestinal
bacteria was significantly different compared to neonates fed by other means. In 1909,
Escherich opened the first human milk bank . The following year, another milk bank
opened in the Boston Floating Hospital, the first milk bank in the US.

 The 1960s saw a decline in milk banking because of recent advances in neonatal care and
baby formula. Despite these new advancements, in 1980 the World Health Organization
and the United Nations Children's fund maintained their position that donor breast milk
is the best alternative to the mother's breast milk. The practice of milk banking declined
further with the HIV epidemic. The need for stringent screening increased the cost of
operating milk banks, forcing them to close doors.

 Improved screening methods and standardization of procedure have made donated milk
a viable alternative to mother's breast milk. The ability to pasteurize and store breast
milk for up to 8 months means milk banking could become a global enterprise.

Donor:-

A donor must:

 Be healthy
 Be in the process of lactation
 Undertake a chest x-ray or Tyne test

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 Have a negative VDRL
 Have no evidence of hepatitis
 Be HIV negative
 Non smoker
 No drug and alcohol user
 Lives a healthy lifestyle

Receipient:-

 Absent or insufficient lactation: Mothers with multiple births, who can not secrete
adequate breast milk for their neonate initially.
 For babies of nonlactating mothers, who adopt neonate and if induced lactation is not
possible.
 Abandoned neonates and sick neonates
 Temporary interruption of breastfeeding
 Infant at health risk from breast milk of the biological mother
 Babies whose mother died in the immediate postpartum period

Equipments:-

 Pasteurizer/Shaker-water bath: It is essential to have a device to carry out heat

treatment of donor milk at the recommended temperature of 62.5 C for a period of 30
minutes prior to its use.

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 Deep freezer:- A deep freezer to store the milk at -20 C is essential in the milk bank.
 Refridgerators:- These are required to store the milk till the whole day’s collection is over
and the milk is ready to be mixed and pooled for further processing.

 Hot air oven/Autoclave:- A hot air oven/ autoclave in the milk bank or centralized sterile
service department is essential for sterilizing the articles needed in the bank.
 Breast milk pumps:- For milk banking, hospital grade electric pumps are preferred as
they result in better volumes of expressed milks and are relatively painless and
comfortable to use.
 Containers:- For collection and storing the milk, single use hard plastic containers of
polycarbonates, pyrex or propylene are used across the world.

 Generator/Uninterrupted power supply:- Every milk bank should have a dedicated

centralized source of uninterrupted power.

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 Milk analyzer:- It is desirable to have macronutrient analysis of breast milk to estimate
the calorie,protein and fat of milk sample.

Indication:-

When a mother’s milk supply is delayed due to circumstances of birth or pregnancy,

including premature delivery.
When a mother’s milk supply does not become established enough to provide sufficient
milk for her child or children(Twins or triplets)
When stress interferes with milk supply, such as when the mother of a hospitalized infant
is unable to hold or directly nurse her baby
When a mother requires medication that may pass through her own milk and harm her
infant
When a mothers has a medical condition that precludes breastfeeding, such as HIV.

Contraindication/Limitation:-

A person who:

 uses illegal drugs, tobacco products or nicotine replacement therapy or

 regularly takes more than two ounces of alcohol or its equivalent or three caffeinated
drinks per day; or

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 has a positive blood test result for HIV, HTLV, Hepatitis B or C or syphilis; or
 is herself or has a sexual partner suffering from HBV, HIV, HCV and venereal diseases OR
either one has high risk behavior for contracting them in last 12 months; or
 has received organ or tissue transplant, any blood transfusion/blood product within the
prior 12 months
 is taking radioactive or other drugs or has chemical environmental exposure or over the
counter prescriptions or mega doses of vitamins, which are known to be toxic to the
neonate and excreted in breastmilk; or
 has mastitis or fungal infection of the nipple or areola, active herpes simplex or varicella
zoster infections in the mammary or thoracic region.

Procedure:-

1. COLLECTION OF BREASTMILK:
After proper counselling, checking suitability for donation, getting written informed
consent, history taking, physical examination and sampling for laboratory tests, the
donor is sent to designated breastmilk collection area in the milk bank or in the milk
collection center. Breastmilk is collected by trained staff with hygienic precautions, after
method of breastmilk expression is chosen by the donor. Home collection of breastmilk
is better avoided at present in our country due of the risk of contamination. Washing the
breast with water before expression is as good as washing with disinfectant. There is no
rationale in discarding foremilk. Drip milk (the milk that drips from the nonfeeding
breast in some of lactating mothers) collected with the help of breastmilk shells has been
found to be nutritionally inferior with lower fat content, and is not recommended for
banking. The breastmilk may be expressed manually (hand expression) or with breast
pumps. Manual expression is a low cost and effective method of expression, and
associated with less risk of contamination. Simultaneous breast expression in
breastfeeding women is more efficacious than sequential breast expression. Milk should
be collected in properly labelled sterile container and transported to HMB under cold
storage condition.

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2. PROCESSING:
 All batches of collected raw breastmilk should be refrigerated immediately till the
serological report comes negative. Fresh raw milk should not be added to the frozen milk
since this can result in defreezing with hydrolysis of triglycerides. While mixing fresh raw
breastmilk to frozen raw breastmilk previously collected from same donor, it should be
chilled before adding to frozen milk. For sick or preterm babies, it is advisable to use a
new container for each pumping.
 Before pasteurization, pooling and mixing may be carried out from multiple donors to
ease the process of processing and storage. Pasteurization is carried out by Holder’s
method.
 Microbiological screening of donor milk is done before (if there is no cost constraint), and
as soon as possible after pasteurization. Pre-pasteurization microbiology can result in
wastage of milk to the tune of about 30% in some cases. Even after pasteurization, the
endotoxins of organisms are still present in the milk in some cases but they have not been
found to have any clinical effect on the baby. A bacterial count of 105 CFU/ mL or more
in raw breastmilk can be considered as an indicator of the poor quality of milk. Based on
this and on the theoretical concern that heavily contaminated milk with specific bacteria
(e.g. S. aureus, E.coli) may contain enterotoxins and thermostable enzymes even after
pasteurization, expert panel selected 105 CFU/mL for total bacterial count, 104 CFU/mL
for Enterobacteriaceae and S. aureus as threshold values, which are in consonance with
milk banks operating in other parts of the world. No growth is acceptable in post-
pasteurization microbiology cultures. Whole batch of culture positive container of
pasteurized milk should be discarded.

3. STORAGE:
Pasteurized milk awaiting culture report should be kept in dedicated freezer/freezer
area taking precaution not to disburse it till the culture is negative. Storage should be
done in the same container that is used for pasteurization. It is advisable not to transfer
processed milk in other containers as it has risk of contamination. Culture negative
processed milk should be kept at -20°C in tightly sealed container with clear mention of

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 expiry date and other relevant data on the label. It can be preserved for 3 to 6 months.
Random cultures of preserved milk before disbursal can aid quality assurance.

Guidelines:-

 Standard operating procedures(SOP) of the bank (which should be displayed at proper

places) should be adhered to.
 Hygienic practices like proper hand wash, donning gowns, mask, gloves, trimming nails,
locking long hairs should be maintained.
 Gloves should be worn and changed between handling raw and heat-treated milk.
 Staff should undergo regular health checks and be immunized against Hepatitis B.
 There should be a program for ongoing training of the staff.

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Benefits:-

 One in eight babies are born preterm

 Human milk is especially important for premature or sick babies, who are at 10 times the
risk for devastating intestinal infections if they are fed formula instead of human milk
 Fewer than half of moms who deliver a baby prematurely are able to provide their babies
with breast milk.Through donor milk, these preterm babies are still able to receive the
benefits of breast milk to help them grow and thrive.
 Some mothers of preterm and sick babies have health complications of their own or may
need medications that prevent them from breastfeeding.Yet the babies of these moms are
able to get many of the life saving benefits of breastfeeding through donated human milk.
 Human milk contains antibodies to fight disease and infection, and also protects against
allergies.
 Human milk contains growth hormones that help babies develop.

Care:-

 Screening should be done before donating the milk or collecting the milk.
 Adequate equipment should be use during breastmilk collection.
 Before collecting the milk from donor, each breast should be cleaned with sterile guaze.
 Strict sterile techniques are follow during collectin and storage.
 Store milk in a clean bottle disposable milk storage bag.
 Fill each bottle with enough milk for one feeding.
 Use a solid cap to create an airtight seal.
 Hold the bottle under warm running water for a few minutes until milk reaches room
temperature.
 Do not warm milk in a microwave or stove, it can destroys nutrients and causes burn to
baby’s mouth.
 Burping is necessary after each feeding.
 Watch for baby’s sign for enough feeding.
 After feeding, baby’s mouth should be cleaned.

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 Locations:-

A. Human milk bank in INDIA:-

 Amara Milk Bank (In collaboration with Fortis la Femme), Greater Kailash, New Delhi
 Lokamanya Tilak Hospital (Sion Hospital), Sion, Mumbai
 Cama Hospital, Fort, Mumbai
 KEM Hospital, Parel, Mumbai
 Sir JJ Group of Hospitals, Byculla, Mumbai
 Divya Mother Milk Bank, Udaipur, Rajasthan
 Dheenanath Mangeshkar Hospital and Research Centre, Pune
 SSKM Hospital, Kolkata
 Institute of Child Health, Egmore, Chennai
 Vijaya Hospital, Chennai
 Kashiba Children Hospital,Gujarat

B. Human milk bank in GUJARAT:-

 Kashiba Children Hospital,Vadodara
 SMIMER Hospital,Surat
 Akansha Hospital,Anand
 Civil Hospital,Ahmedabad

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 Bibliography

1. Dutta’s DC, TEXTBOOK OF OBSTETRICS, 9th edition;2019, Jaypee publishers, Pg No: 421-
425
2. Jacob Annamma, A COMPREHENSIVE TEXTBOOK OF MIDWIFERY AND GYNECOLOGICAL
NURSING, 4TH edition; Jaypee publishers, Pg No:253-254
3. Kaur Sandeep, TEXTBOOK OF MIDWIFERY AND GYNECOLOGICAL NURSING, CBS
publishers; Pg No: 125
4. Naik Sweta, Hannah Roseline D, PROCEDURE MANNUAL FOR OBSTETRIC AND
GYNECOLOGICAL NURSING, CBS publishers; Pg No: 401
5. Podder Lily, FUNDAMENTALS OF MIDWIFERY AND OBSTETRICAL NURSING, Elsecier
publishers; Pg No: 394
6. https://www.slideshare.net/rahulmoothedan/human-milk-banking-presentation
7. https://www.indianpediatrics.net/june2014/469.pdf
8. https://www.karger.com/Article/FullText/452821
9. https://www.milkbank.org/milk-banking

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