Banking on Human Kindness

Donor Milk

Pauline Sakamoto MS, RN, PHN

Executive Director

Past President of HMBANA

US Breastfeeding Committee Member

MOTHER’S OWN MILK IS THE

FIRST CHOICE

WHEN MOM IS INSUFFICENT OR NOT

AVAILABLE FOR AN INFANT IN NEED

THEN PASTEURIZED HUMAN DONOR

MILK IS USED

HMBANA’s Mantra

Chief bottle washer

What makes us different We’re dedicated to ensuring that every infant has ample breast

milk to get the best possible start in life.

It’s a new day

Breastfeeding timeline by Kellogg Foundation

http://www.youtube.com/watch?v=Zhx-R6p1xAQ&list=UUAYYMRv_yBzT4gP2-uB9r4A&index=1

Making a comeback

• Established in 1974

• Helped found Human Milk Banking Association of North America in 1985

• Become a Medi-Cal provider 1988

• Licensed as a California Tissue Bank 1995

Bursting at the

seams

We may be the greatest

thing since banked milk,

but we’re still elbow to

elbow in a 30 year old

trailer

New digs

What makes us different

• Sole non-profit milk bank in California

• Distribute milk to the most vulnerable

• All processing charges support research, education, HMBANA and breastfeeding!

• Preterm Infants

• Other infants, children and adults: – allergies or sensitivities to formulas

– failure to thrive (FTT)

– immune deficiencies

– malabsorption syndromes

– post-surgical nutrition

– short gut syndrome

– solid organ transplants (including adults)

– cancer chemotherapy patients / apoptosis

– renal failure (replenish IgA)

Clinical Uses of Donor Human Milk

This is me feeding my son donated breast milk from

San Jose Milk Bank.

Thanks Mamas! He got a great start with your help! And it meant so

much to my peace as I fight my battle with breast cancer.

• Given donor #

– no milk accepted until all screening complete

• Donates milk – frozen

• Milk thawed to a slurry

• Milk cultured

• Holder pasteurization (62.5 C X 30 min)

• Milk re-cultured

• Frozen for storage and shipping

HMBANA Donor Milk Processing

Northern California landscape

Hospital Serve

• 103 hospitals in

thirteen states

• We are serving four

hospitals’ NICU’s in

the Sacramento area.

Impact

Largest Distributing US

milk bank – Over 572,000 oz last year

– 93 hospitals

– 86 outpatients in 13 states

– 680 volunteer donors!

A donor milk baby tasting his first spaghetti

Growing Sacramento Area

Local Community Outreach

– Milk Drives

– Express Centers

– 6 Hospitals and growing

– Outpatient Support

Yearly Ounces Distributed

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Year

Totals

572,700 (20.49% increase)

465,363 (1.33% increase)

Infant Diagnoses 55%

Maternal Diagnoses 43%

Adult Diagnoses 2%

San Jose Diagnosis Codes by Population

Mentoring new banks

A big thank you to all of the staff for taking time out of your day to teach us what you know. It is a huge step toward getting the milk bank up and running in Montana!—Mothers’ Milk Bank Montana

Mothers’ milk supporters

• Surgeon General calls for greater availability of safe banked donor

human milk for fragile infants, 2011

• FDA Pediatrics Advisory Committee endorses human milk banking and deemed informal sharing of human milk to be unsafe, 2010

• WHO/UNICEF “In situations where mothers’ own milk is not available, provisions of pasteurized, screened donor milk is the next best option particularly for ill or high risk infants.” 1980

• The AAP REDBOOK Currently, US donor milk banks that belong to the Human Milk Banking Association of North America voluntarily follow guidelines drafted in consultation with the US Food and Drug Administration and the Center for Disease control and Prevention. 2000

More supporters

ACOG,” The Human Milk Banking Association of North America (HMBANA) is the only professional membership association for milk banks in Canada, Mexico, and the United States, and sets the standards and guidelines for donor screening, storage, sterilization of milk, and modern distribution methods.” 2007

American Academy of Family Physicians “Banked pasteurized donor human milk has been found to be safe and nutritionally sound for babies who do not have access to their mother’s own milk.” 2008

American Dietetic Association. “The value of human milk in reducing the incidence of [necrotizing enterocolitis] NEC has influenced the growing use of pasteurized donor human milk for infants at high risk for NEC (37-41). When mother’s milk is not available, providing pasteurized donor milk from appropriately screened donors from an approved milk bank offers immunoprotection and bioactive factors not found in infant formula and is the next best option particularly for ill or preterm infants. 2009

US Department of Health and Human Services “S/he may need donor milk, not only for food but survival. If your baby was born premature or has other health problems, the best way to find a human milk bank is through the HMBANA (Human Milk Banking Association of North America)”

Our donors

• Eligible blood

donors are

likely eligible

milk donors

• We fill

doctors’

prescriptions

Screen, process, test

• Thawing for bacterial

testing

• Holder Pasteurization,

bacteria testing of all

milk

Sometimes we need to bust out http://www.youtube.com/watch?v=WX4VWBeavGg

Help wanted

• We seek your help in

reaching donors so

that every baby has

ample breast milk to

thrive.

The future is in our hands

Bibliography

Edwards, TM, Spatz, DL, Making the Case for Using Donor Human Milk in Vunerable Infants, Adv Neonatal Care, 2012 vol 12, No5, pp 273-278

Sullivan, S, Schanler R, Kim J, et al, An Exclusively Human Milk-Based Diet is Associated with a lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products, Journal of Peds, 2009, 10.106

Penn, AH, Altshuler, AE, Digested formula but not digested fresh human milk causes death of intestinal cells in vitro: Implications for necrotizing enterocolitis, Peds Research, 21 nov. 2012, doi:10.1038/pr.2012.125

AAP, Breastfeeding and the Use of Human Milk, Peds, Vol129, Number 5, 3/2012

Cohen, RS, Current Issues in Human Milk Banking, NeoReviews, vol 8, No.7, July 2007

Gardner LM, Morton J, Lawrence R, Breastfeeding and the Use of Human Milk, Peds, 2005, vol 115, no 2, 496-506

Boyd CA, Quigley MA, Brocklehurst, P, Donor Breast Milk vs Infant Formula for Preterm Infants, A Systematic Review, Arch Dis Child, Fetal Neonatal Ed. Online, 5 Apr 2006

• Updegrove K, Human Milk Banking in the US, Newborn and Infant Reviews, vol 5, no 1 March 2005, 27-33

• Arnold,L The Cost Effectiveness of Using Banked human donor Milk in the Neonatal Intensive Care Unit, Jr. H Lact, vol 18, no 2, 2002

• Wight, NE, Donor Human Milk for Preterm Infants, Journal of Perinatology, 2001, 21-249-254

• HMBANA, Guidelines for the Establishment and Operation of a Donor Human Milk Bank 2011 ( soon to have 2013 ed)

• Jones, Frances, Best Practice for Expressing, Storing and Handling Human milk in Hospitals, homes, and Child Care Settings, 2011, 3rd edition

• And more if requested!