Human Milk Banking in the care of the Premature Infant

NCT Conference May 15th 2010Telford

Donor breastmilk for babies

Countess of Chester HospitalCountess of Chester Hospital2000-20102000-2010

Lynda Coulter

Former Senior Neonatal Nurse Practitioner

Human Milk Bank Manager

For the

Protection

Promotion

Support

of

BREASTFEEDING

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

A Hundred years of Donor Milk Banking A Hundred years of Donor Milk Banking

Vienna 2009Vienna 2009

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.”

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!!!!!!!!

National GuidelinesNational Guidelines

PreparationPreparation

SievingSieving

BottlingBottling

PasteurisingPasteurising

TransportationTransportation

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

NICE NICE ShortShort Clinical Guideline Clinical Guideline

132 pages132 pages

NICE GuidelinesNICE Guidelines

Donor breast milk banksCurrently Implementing NICE guidance

&

Working towards

National Standards2010

NICE clinical guideline 93

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

• 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

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

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)

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

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

Women donate to breast milk banks to help others' babies

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

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

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…………………….

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)

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

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

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

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

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

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

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

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

Donor milk helped meDonor milk helped me

My growth on donor milkMy growth on donor milk

Donating MilkDonating Milk