Human Milk Banking in the care of the Premature Infant
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Transcript of Human Milk Banking in the care of the Premature Infant
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NCT Conference May 15th 2010Telford
Donor breastmilk for babies
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Countess of Chester HospitalCountess of Chester Hospital2000-20102000-2010
Lynda Coulter
Former Senior Neonatal Nurse Practitioner
Human Milk Bank Manager
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For the
Protection
Promotion
Support
of
BREASTFEEDING
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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.
Definition
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A Hundred years of Donor Milk Banking A Hundred years of Donor Milk Banking
Vienna 2009Vienna 2009
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WHO / UNICEFWHO / UNICEFJoint Resolution 1980 (Post 70’s)Joint Resolution 1980 (Post 70’s)
“ Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of Human Milk from other sources. Human Milk Banks should be available in appropriate situations.”
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Provision for North West Donor Milk Provision for North West Donor Milk Bank ServiceBank Service
Historically in the UK milk banks funded and resourced on a local level
This is the first regional service developed from Charitable Funds
Making the first moves to strategically meet the demands for a national service
2009 NICE GUIDELINES!!!!!!!!
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National GuidelinesNational Guidelines
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PreparationPreparation
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SievingSieving
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BottlingBottling
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PasteurisingPasteurising
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TransportationTransportation
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from Endorsement to
Guidelines and
recommendations
DOH commissions NICE
to write a short clinical guideline
Donor breast milk banks:
the operation of donor milk bank services
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NICE NICE ShortShort Clinical Guideline Clinical Guideline
132 pages132 pages
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NICE GuidelinesNICE Guidelines
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Donor breast milk banksCurrently Implementing NICE guidance
&
Working towards
National Standards2010
NICE clinical guideline 93
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Milk Banks in the UKMilk Banks in the UKBirmingham
•Women's HospitalCambridge
•Rosie Milk BankChatham
•All Saints HospitalChertsey
•St Peter’s HospitalChester
•Countess of Chester HospitalOrpington
•The Princess Royal HospitalGlasgow
•Queen Mother’s HospitalHalifax
•Calderdale HospitalKingston
•Kingston HospitalLondon
•King’s College Hospital•St George’s Hospital•Queen Charlotte’s Hospital•St Thomas’ Hospital
N.Ireland
• Irvinestown Health CentreOxford
•John Radcliffe HospitalSouthampton
•Princess Anne HospitalWirral
•Arrowe Park Hospital
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• Research has shown that breast milk is the best nourishment for babies and it is highly beneficial to their health in the short, medium and long term.
• Donor breast milk is neither widely nor readily available in the majority of hospital or neonatal units.
• Improvement in the operation of milk banking will increase cost effectiveness
Source: Health Technology Assessment (HTA) report 2009 Breastfeedingpromotion for infants in neonatal units: a systematic review and economic analysis
Background
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The Research 2000 onwardThe Research 2000 onwardDonor Breastmilk versus Infant Formula for the preterm infants;
A systematic review and meta analysis
Boyd et al, April 2006
Banking for the future: Investing in Human Milk
A.F. Williams, C.C. Kingdon, G. Weaver
Arch.Dis.Child.Fetal Neonatal Ed. 2007 92:158-159
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Health Economic Health Economic ConsiderationsConsiderations
Earlier enteral feeding
Reduced incidence of NEC
Reduced systemic infections
Reduced formula milk expenditure
Chester Circa (£8,000) per annum
The Alternative:
TPN @ £150 per day (inc. antibiotics)
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Why donor breastmilk
•Artificial milks necessarily lack the protective elements contained in human milk to help to mature the infants immune, digestive and neurological systems
•Artificial milks also cannot replicate the hormonal components such as leptin that help to regulate appetite
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GLOBAL PERSPECTIVE: USA
“Breast Milk Banks fill need”
“I think it must be similar to what people who receive donated blood must feel, This kind of gift is so personal and can be monumental for those who receive it” says Shaw
Trevor Hughes USA TODAY
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Women donate to breast milk banks to help others' babies
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Future PlansFuture Plans
Provision of Human Milk for premature babies
(In the North west & further if needed)
Support a Local, Region, & National Service
Ability to supply the demand for milk
Support Regional Centres’ interest
Provision of a facility for audit & research
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Donor Breast Milk Donor Breast Milk Conference 2010Conference 2010
Donor breast milk in the care of the neonate
The rationale for human milk feeding in the very preterm Infant
Dr Colin Morgan, Consultant Neonatologist, Liverpool Women’s Hospital, Liverpool
Current immunology research: Human breast milk: a rich and novel source of regulators of microbial
recognition by Toll-like receptorsDr Mario O Labéta, Senior Lecturer, Medical Biochemistry
Henry Wellcome Research Unit, Cardiff University School of Medicine
Lactoengineering: manipulating the protein content of human milk
Dr Antoni Gaya, Consultant ImmunologistHuman Tissue & Milk Bank, Majorca, Spain
Donor breast milk in neonatal careProfessor Neena Modi, Professor of Neonatology
Chelsea & Westminster Hospital, London
Using donor breast milk: an opportunity to change attitudes to all neonatal feeding on a neonatal unit
Dr Camilla Kingdon, Consultant NeonatologistSt Thomas’s Hospital, London
DebateShould we use donor breast milk in the care of the
neonate?Case for: Dr Colin Morgan
Response: Professor Neena Modi
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Donor breastmilk
Promotion of services
Recruitment of new donors
Increasing awareness of availability
Increasing the demand for donated milk from milk banks…………
WE NEED YOUR HELP…………………….
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Chester Milk Bank ActivityChester Milk Bank Activity
688 donors since May 2000
62 donors in 2003
68 donors in 2004
74 donors in 2005
94 donors in 2006
101 donors in 2007
139 donors in 2008
170 donors in 2009
4070 litres pasteurised
15/20% discard rate
1800 litres distributed to other hospitals
5.9 litres (average per donor)
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Number of Donors
0
20
40
60
80
100
120
140
160
180
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
Number of Donors Out of area donors
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Volumes Pasteurised
0
200
400
600
800
1000
1200
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
Milk Pasturised
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Batches Pasteurised
173
356315
427 429 440
578
0
100
200
300
400
500
600
700
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
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Milk Volumes Distributed
0
100
200
300
400
500
600
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
Milk Used by Countess Of Chester Hospital Milk to other Trusts
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Recipient: Hospital DistributionTameside Hospital
Bradford Hospital
Wrexham Hospital
Southmead Hospital
Wythenshawe Hospital
St. Mary's Hospital
Glan Glwyd Hospital
Sheffield Hospital
Royal Lancaster
Liverpool Women's Hospital
Stepping Hill Hospital
North Staffordshire
Pontefract Hospital
Hope Hospital
Ysbyty Gwynedd
Furness General Hospital
Diana Princess of Wales
Doncaster Royal Infirmary
Royal Bolton Hospital
Lister Hospital
Hull Royal Infirmary
University Hospital of Wales
Warrington Hospital
Leeds Hospital
Leighton Hospital
Ormskirk Hospital
Rochdale
Whiston Hospital
Royal Albert Edward Infirmary
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Pasteurised & Discarded Batches
0
100
200
300
400
500
600
700
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
No. Batches No. Discardes Batches
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Reasons for Discard
0
10
20
30
40
50
60
70
2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
Staph aureus Coliform > 10 6 Others
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Donor breast milk
It would be desirable to expand the human milk donation service to the same level of coverage as the blood donation service so that any mother who for whatever reason could not feed her baby at the breast would be offered the option of feeding her baby with human milk
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Donor milk helped meDonor milk helped me
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My growth on donor milkMy growth on donor milk
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Donating MilkDonating Milk