Human Milk Bank Processes: YOUR FACILITY AND LOCATION

Edith Pereira

Nutritionist, MSc

Responsible for Human Milk Bank from Hospital Dr. Agostinho Neto – Praia, Cap-Vert.

Email: [email protected]

Skype: edithpereira.76

Telephone: 002382602166

How did your human milk bank (HMB) began? When?

Who provided initial funding? How are ongoing operations funded? Integrated into government services?

Background info

Brief description

In 2008 a technical team of Brazil (FIOCRUZ) in Cape Verde was to establish the diagnosis of maternal and child health project aimed at elaboration of technical co-operation for implementation of human milk bank. The HMB are functioning in 2011 Ministry of Foreign Affairs to Brazil - ABC ( Brazilian Agence of Cooperation) Most of the funding has already been granted Yes, rather through the Ministry of Health of Cape Verde Who regulates /oversees HMB in your country/region (if any)?

Is under preparation of a regulation to be supervised by the Regulatory agency for pharmaceuticals and food (ARFA) How many HMBs are part of your system? Where are they? One HMB. In the largest Hospital in the Country – Hospital Dr. Agostinho Neto, Praia, Ile de Santigo, Cape Verde. Is there a central HMB that processes milk and distributes or many HMBs that process milk and distribute? (Centralized vs de centralized) How many NICU/Neonatal wards/community homes does each bank serve? Are they collocated? How many babies does your facility/system serve annually?

How many liters/year does your facility/system process annually?

Central HMB One Neonatal 243 babies (Avril to October 2012) 71 liters (Mars to October 2012) How many donor mothers initiate donation to your facility/system annually?

214 mothers (January to October 2012) Page 2

Process

Staffing Donor recruitment Donor screening Recipient eligibility and selection Handling and storage of donor milk (from donation to feeding)

• • • • •

Brief description of processes

One Nutritionist, two nurses (full time) one laboratory technician and two doctor (part time) In this first implementation phase of HMB, the donors are recruited in Maternity Hospital. A communication plan is being prepared to start collecting at home.

Donor mothers are considered healthy. For some information that is collected in the state of health of the mother, the doctor and then analyzes the mother is deemed fit to donate milk.

By key receptors are premature and newborn infants of low birth weight that does not suck; newborns with enteroinfeções; immune deficiency; protracted diarrhea; allergy sufferers will heterologous protein and other exceptional cases at the discretion Doctor.

Milk is collected in sterile bottles donated by BLH. The donated milk to feed another baby is stored in a freezer for 15 days. Within this period of 15 days, the milk is pasteurized. Pasteurized milk is stored for 6 months. All the HMB refrigerators are monitored temperatures

Process

Transport of milk Pasteurization Tracking and record keeping Assessing milk quality and safety (ie. microbiology assays)

Brief description of process

• The milk taken in HMB is frozen for a period not to exceed 15 days. In the case of the household collection, the milk is transported in a cooler and makes up the temperature control before the start of the collection, the donor's home and on arrival at HMB. This first phase is to use the car's Hospital.

• Pasteurization is done at 62,5°C for 30 minutes after the time of • • • preheating.

Adjust the water bath temperature sufficient to reach 62,5°C Place the vials containing milk to be pasteurized (with lid semi-closed).

Start timing of pasteurization according to curve pasteurization, agitating the vials and noting the time every 5 minutes.

After the total time of pasteurization, cooling the milk • • All information is recorded in allowing a tracking . At the beginning of December will be mounted information system network HMB.

The microbiological quality of the milk is made by analyzing microbial inoculation of milk samples in solution of brilliant green bile broth.

Quality assurance • Quality assurance is made ​​according to the following parameters: Dornic acidity, off-flavor, dirt, color and presence of coliforms.

Equipment/Location

What is used/how many?

Additional HMB equipment requirements?

• • • • • • • • •

Brief description of process

Pasteurizer - one Freezers – one Refrigerator – two Chiller - One ‘’Centrifuge’’ ‘’Acidimetro’’ – One – One ‘’Deonizador ‘’– One Computers - One Printer – One

Referral/feeder/depot facilities?

Neonatal ward equipment requirements?

Other?

Policy Operational

Organizational Successes

Brief description of top 3-5 successes

• • • Increased awareness of mothers for exclusive breastfeeding until 6 months of age; Decrease in the cost of hospitalization, Decreased length of hospital stay; • • • • Donors have the knowledge of their state of health.

The newborn babies receive the most appropriate food. All mothers with breastfeeding difficulties receive support from HMB Well trained staff

Technology

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Policy

Organizational Challenges

Brief description of top 3-5 challenges

• • Be the center of reference in the African for the Brazilian Network of HMB Implementation of legislation regulating the functioning of the HMB

Operational

• • • • Have a team formed with more professional; Implementation of HACCP; Implement the collection of household milk; Elaboration of a communication plan

Technology

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OBRIGADA

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OBRIGADA

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