Transcript Document

Human Milk Bank Processes:
King Edward Hospital Fuchs Milk Bank, Durban,
South Africa
Anna Coutsoudis
Professor,
Dept Paediatrics & Child Health.
University KwaZulu-Natal
Durban, South Africa
[email protected]
Background info
Brief description
How did your human milk bank (HMB) began?
When?
Began in response to a need for low birth weight infants in the NICU whose mothers could
not provide breatmilk to receive donor milk instead of preterm formula milk. Risk of NEC
and feed intolerance were reported by staff and head of NICU to be a major problem.
Began in 2009
Who provided initial funding? How are
ongoing operations funded? Integrated into
government services?
Initial funding provided by Carl and Emily Fuchs Foundation. Sicne 2011 when funding ran
out Prof Coutsoudis has been paying the salary of the breastmilk bank manager from her
own discretionary research funds - Not integrated into government services.
Who regulates /oversees HMB in your
country/region (if any)?
Oversight (very limited) provided by Human Milk Banking Association of South Africa.
No government oversight yet, although is being planned.
How many HMBs are part of your system?
Where are they?
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Is there a central HMB that processes milk
and distributes or many HMBs that process
milk and distribute? (Centralized vs decentralized)
Decentralised – but current province local government plans are to have a central bank
that processes and then distributes. Banks will collect their own donor milk and transport
to central bank.
How many NICU/Neonatal wards/community
homes does each bank serve? Are they
collocated?
Serves its own neonatal ward
How many babies does your facility/system
serve annually?
About 80– could be much more if had more milk and more ownership from the whole
health care team
How many liters/year does your
facility/system process annually?
70 – 80 litres
How many donor mothers initiate donation to
your facility/system annually?
60-70
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Process
Brief description of processes
Staffing
•
1 breastmilk bank manager who is responsible for screening mothers and organsing
HIV testing (sometimes assisted by the counsellor). She is also trained as a lactation
consultant and is expected to assist mums with breastfeeding and to encourage
women to donate
Donor recruitment
•
In the hospital from mothers whose babies are not yet ready for discharge – low birth
weight babies being fed on expressed breastmilk
Donor screening
•
Screening form for lifestyle risks – similar to blood donor screening and HIV and
syphylis tests from pregnancy – if HIV test from pregnancy is negative then a repeat
test is done on the day of screening.
Recipient eligibility and
selection
•
No infections, healthy mother
Handling and storage of
donor milk (from donation
to feeding)
•
Mothers given sterile glass bottle into which to express breastmilk. Before expressing
mothers wash hands and wipe breasts down with antibacterial swab. Once milk is
expressed mothers record donor number and date of expression on bottle. Milk is
given to breastmilk bank manager who immediately pasteurizes it and after cooling
freezes it or it can be placed in fridge for immediate use. If she is too busy to
pasteurise immediately, milk is frozen for later pasteurisation.
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Process
Brief description of process
Transport of milk
•
Manager collects milk from mothers’ homes or collection depots in cooler box with
ice packs and transports it to milk bank
Pasteurization
•
Flash heating – using newly developed MMM pasteuriser
Tracking and record
keeping
•
Each pasteurisation has batch number, temperature logging on phone screen and can
be relayed to remote server.
Assessing milk quality and
safety (ie. microbiology
assays)
•
Micro assays on post-past’n sample –each new donor has first sample assayed.
Quality assurance
•
Screening of mothers, HIV and syphilis test results, issue of sterile collection bottles;
temperature control of freezers; temperature monitoring of pasteurising and cooling;
batch numbers and donor number on each bottle; expiry date on each bottle
Equipment/Location
Brief description of process
What is used/how many?
• 1 x MMM pasteuriser
• 1 x Freezer for unpasteurised and pasteurised milk – kept
separate
• 1 x Refrigerator
• 450 ml glass milk collection bottles
• 125 ml glass storage bottles
Additional HMB equipment • Separate room with stainless steel surfaces and washing
facilities
requirements?
Referral/feeder/depot
facilities?
• none
Neonatal ward equipment
requirements?
• none
• none
Organizational Successes
Brief description of top 3-5 successes
Policy
• Advocacy work together with PATH led to National/regional policy and
support for breastfeeding as well as roll out of donor milk banks.
• Publication on feasibility and safety of setting up a low cost donor milk
bank in resource limited settings (BMC Public Health 2011)
Operational
• Improved health outcomes – see case studies ……
Technology
• Originally were using flash heating methodology developed by IsraelBallard et al – discomfort with certain things eg heating without lid, only
one bottle at a time; no temperature monitoring – concern with over-or
under-heating – collaboration with PATH and UW – Gates Foundation
funding developed MMM pasteuriser.
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Case Study
• Infant A was born at 32 weeks gestation (birth weight: 1.7kg) to a
33year old HIV negative, para 3 mother following a caesarian
section for severe pre-eclampsia. Mother had left arm paralysis
since adolescence following a head injury. She had chosen to
breastfeed antenatally, however the nurses decided as she had a
paralytic arm, she would be unable to hold her baby and started her
baby on formula. NEC developed on day 2 following formula feeds
(abdominal distension; feed intolerance; severe umbilical flare;
dilated visible bowel loops; and pneumatoses on abdominal X-ray).
Feeds were discontinued for 2 days, following which breastfeeding
was initiated by the mother supported by the study doctor. Donor
milk was given for four days while the mother’s milk was coming
down. NEC resolved after 6 days on treatment. Baby was doing well
and discharged on breastfeeds and expressed breastmilk top-ups, 4
days after resolution of NEC.
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Case Study
• Infant B was born at 29 weeks gestation (birth weight 1.1kg) to a 41
yr old HIV negative, para 4 mother, with previous breast cancer and
therefore not planning to breastfeed. Infant received formula milk
feeds for the first 3 weeks of life and developed NEC (abdominal
distension, vomiting, bloody stools and thickened bowel wall on
abdominal X-Ray). He was taken off feeds for 5 days and then
commenced on donor breastmilk for a further 3 weeks until
discharge. Did extremely well on donor breastmilk and showed
marked clinical improvement. In fact during the period of receiving
donor breast milk the nursing staff attempted re-introducing
formula feeds but these were not tolerated at all and were
accompanied by projectile vomiting so were discontinued and donor
breastmilk re-introduced.
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Organizational Challenges
Brief description of top 3-5 challenges
Policy
• Uncertainty around importance of donor milk, health care workers more
comfortable working with formula milk, more experience.
• Lack of policy level support for breastfeeding promotion.
• Lack of guidance from Ministry of Health
Operational
• Funding for dedicated staff – staff normally wearing 2 or 3 hats
• Insufficient donor milk due to insufficient donors – poor breastfeeding
promotion – leads to many women discontinuing breastfeeding at 4
months
Technology
• Achieving optimal pasteurization throughput balanced against wastage
on the neonatal ward with higher processing volumes (Pasteurizing in
125ml bottles when only 25 ml/baby is used)
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