Prof. Dr. Arun Singh is H.O.D. Department of Neonatology, IPGMER & SSKM, Kolkata. The video highlights the numerous ways in which deficiencies can be prevented, including the protection breast milk offers. As donor milk is not really available, creating a bank will be beneficial for exigencies that may arise. Benefits of banking breast milk far outweigh the challenges. Giving the example of creating dedicated feeding spaces as a pilot, Dr. Arun highlights how a model like this can function effectively and the conditions under which donors can avail of such a facility. Comparing a milk bank to a blood bank, the idea is to create a service that collects screens and dispenses human milk by prescription.
Donor breast milk is defined as breast milk expressed by a mother that is then processed by a donor milk bank for use by a recipient who is not the mother’s own baby. A human 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 intent. First such milk bank was started in 1911 by two Boston physicians in the United States who were concerned about the high death rate in an orphan asylum in their community. The first human milk bank in the United Kingdom opened at Queen Charlotte s Hospital, London in 1939.
Collection of the milk can be done by hand expression, manual pump, electric breast pump, pump kit, sterile storage, and containers. Training the donor is also important. The donor would need to be told about hand washing and its importance, good personal hygiene, collecting and expressing milk including cleaning and using breast pumps and containers, storing milk ( cooling and freezing), labelling donated milk and documenting storage conditions and transporting. Bacteriological testing of milk is done by the following ways. All bottles of donor milk should be tested for counts of bacteria. CLED or Columbia agar is suitable media for testing for bacteria. 24 hour incubation of agar plates is sufficient. Discard the samples if they exceed a count of 100000 colony-forming units (CFU)/ml for total viable microorganisms or 10000CFU/ml for Enterobacteriaceae or 10 CFU/ml for Staphylococcus aureus.
Quality assurance is done by using Hazard Analysis and Critical Control Point (HACCP) principles in all quality assurance processes. Validate, calibrate and maintain all equipment used in milk handling and processing and keep records of this. All donor milk administered should be from milk banks that can demonstrate adherence to the guidance.
Handling donor milk at the milk bank is done in the following ways. Before pasteurisation, test a sample from each batch of pooled donor milk for microbial contamination and discard it samples exceed a count of 100000 colony-forming units CFU/ml for total viable microorganisms or 10000 CFU/ml for Enterobacteriaceae or 10000 CFU/ml for Staphylococcus aureus. Test pasteurised donor milk for microbial contamination either at least once a month or every 10 cycles and on an ad-hoc basis if any new processes, equipment or staff are introduced.
Breast milk a perfectly balanced source of nutrition and it is a living substance more complex than blood that contains a variety of nutrient and immunological factors that cannot be replicated.