Human Milk Banking

1. Human Milk Banking Rachel N Musoke Professor Paediatrics/Neonatology Department of Paediatrics & CH University of Nairobi, Kenya Human milk banking - KPA April 2019

2. History: Milk banking • HMB is more than 100 yrs old • Has been refined and made more safe • Receiving donor human milk is 100 times safer than receiving blood! • Should not be confused with ‘human milk sharing’ Human milk banking - KPA April 2019

3. “Human Milk is Essential to Newborn Care” • WHO/UNICEF recommendations: • Exclusive human milk feeding • Mother’s own milk (MOM) • When MOM is not (yet) available – donor human milk (DHM)next best option (where safe HMB facilities are available) • 2008 WHA Resolution 61.20 called on countries to make DHM available Human milk banking - KPA April 2019

4. What makes donor human milk safe? Donor • Rigorous Donor Screening • Lifestyle • Maternal diseases and Medications • Serology • Strict contraindications (permanent or temporary) • Educationon breastmilk expression & storage (if done at home) specified containers Human milk banking - KPA April 2019

5. What makes donor human milk safe? Operative procedures in the milk bank • Good Manufacturing Practice and Hazard Analysis Critical Control Point (HACCP) • From donor to recipient • Bacteriology pre & post processing • Storage before & after pasteurization • Record keeping and documentation Human milk banking - KPA April 2019

6. What makes donor human milk safe? Pasteurization methods • Low temp, long time: Holder pasteurization– 62.5oC for 30minutes • High pressure processing • High temp short time 72oC for 15 seconds (Flush-heat) • Effect on compositions Human milk banking - KPA April 2019

7. Milk bank processing Work top Laboratory Human milk banking - KPA April 2019

8. Milk bank processing PiAstra equipment Flush heat treatment Human milk banking - KPA April 2019

9. Types of HMB & donors • Working within MBFHI • HMB • Stand alone • Within the hospital complex • Donors • Mothers within the hospital – esp NBU & KMC • Mothers of term infants – from home • Pooled or not Human milk banking - KPA April 2019

10. Recipients • Recipient baby – informed parental consent • Usually VLBW but can be any in need • Mother’s milk not available or partially so • Limited period while working with mother • Traceable donor through records or not Human milk banking - KPA April 2019

11. Kenyan studies: Nairobi 1. Joyce Munge 2011 • 102 mothers in Pumwani Maternity Hospital – 87.4% support HMB 2. Kelvin Kiplimo 2018 • 51 mothers in Kenyatta National Hospital – 80.% no knowledge; 90% would donate but 47% would accept use Human milk banking - KPA April 2019

12. Kenyan studies: Nairobi The road to establishing HMB (2015-2017) • 3.Research: APHRC, PATH, MOH, UON, UNICEF • Quantitative – 981 mothers • Qualitative – 17 FDGs, 21 KI, 25 ID • The visit to South Africa • Training & development of guidelines Human milk banking - KPA April 2019

13. Study 3 findings Human milk banking - KPA April 2019

14. Study 3: Views on donating to HMB • 78% of the mothers would donate. • 80% not particular on the recipient. • Preferred recipients(for those who were particular) – any child in need of BM(64%), Orphans (59%) relatives (22%),very sick child (21%). • 80% would not donate to irresponsible mothers Human milk banking - KPA April 2019

15. Study 3 Views on feeding children on DHM from HMB 59 % would allow their children to be fed on donated human milk from HMB Mothers (70%) whose children had complications at birth more like to allow (P=0.05) Majority would accept DHM from any healthy mother (55%) and relatives (24%) Human milk banking - KPA April 2019

16. HUMAN MILK BANKING Concerns on donating HM to a HMB “In a case where a family member needs, like let's say my sisters kid, my cousin's kid and the owner of the baby actually approaches me and asks me to do that, of course I'll try my best to do, but my problem is, donating my milk it is in a bank somewhere, I don't know, okay, I don't know… IDI mother” “Like being unsure, what are you going to do with my milk? You know, and there are those bad stories of they took my hair, they took my nails and I don’t know went where” KII- health worker) Human milk banking - KPA April 2019

17. Ethics, Acceptability & Concerns • Muslims – milk kinship • HIV • African culture? • Cost & sustainability • Donor: Compensation/ renumeration / commecialisation Human milk banking - KPA April 2019

18. Our first HMB 2019! Human milk banking - KPA April 2019

19. Thank you Human milk banking - KPA April 2019

20. Human milk banking - KPA April 2019

21. Hazard Analysis Critical Control Point (HACCP) 4 steps Step 1: From donor to recipient • Assemble multidisciplinary HACCP team • Describe product/process • Identify the intended use/consumer • Construct a flow diagram of process • On-site verification of flow diagram Human milk banking - KPA April 2019

22. Hazard Analysis Critical Control Point (HACCP) 4 steps • Step 2: Identify potential hazard to each process • List potential hazards, conduct hazard analysis and determine control measures • Determine Critical Control Points (CCP's) • Establish critical limits for each CCP • Establish a monitoring system for each CCP • Establish corrective actions for deviations from critical limits • Establish verification procedures Human milk banking - KPA April 2019

23. Hazard Analysis Critical Control Point (HACCP) 4 steps Step 4: Establish monitoring system for each CCP: Record keeping and documentation to include: • Written plans • Corrective actions • Adjustments for deviations Human milk banking - KPA April 2019