The Human Milk Bank at Paropakar Maternity and Women’s Hospital is a significant milestone in newborn care
The superior value of human milk in the nourishment and treatment of conditions associated with prematurity and other neonatal illnesses can ensure the best beginning of human life not only for normal babies but even the babies who are born small and are sick.
Human Milk Bank is a service established to collect, screen, process, store, and distribute donated human milk to meet the specific needs of babies. A human milk bank constitutes the following components for its successful implementation.
- A dedicated team consisting of the advisory board, milk bank head, coordinator, technical group to counsel mothers and help for expression, milk bank technician for pasteurization of breast milk and microbiological surveillance, milk bank attendant for collecting, sterilization of the containers and maintaining hygiene
- Sufficient space to prepare, screen, pasteurize, and store donor milk and to make donors feel comfortable donating their breast milk.
- Equipment like pasteurizer, deep freezer, refrigerator, autoclave, breast pumps, containers, and a generator to ensure continuous power supply and a milk analyzer to have a macronutrient analysis of breastmilk to estimate calorie, protein, and fat of milk sample.
- Donor recruitment strategies using promotional media in facilities and community
- Serological screening for infectious diseases.
The current feeding recommendation for a neonate’s health maintenance and ideal growth & development is to latch the baby directly to the mother’s breast or provide expressed milk from her mother, then pasteurized donated human milk. However, many babies are deprived of their mother’s milk and are given formula feeds because of the baby’s inability to suck due to prematurity, being too small to suck, maternal illness, abandonment or death, and sometimes due to delay in milk production.
Breast milk, which is the exclusive source of nutrition for the initial six months of life and a vital part of a child’s diet for the next 2 years or more is superior to alternatives like bovine milk or formula in terms of nutritive value, immune function, and functionality of other bioactive and growth factors. Problems like diarrhea, indigestion, vomiting, constipation, allergies, delayed growth, respiratory problems, and increased hospitalizations are commonly seen in babies who are deprived of their mother’s milk.
Suboptimal breastfeeding rates
The mother and the baby may experience conditions such as severe illnesses where breastfeeding might not be possible, though this is temporary most of the time. Similarly, a mother who is stressed out such as in emergencies or some personal or familial matters may have a decrease in breastmilk production. It is in this critical setting where mothers are most vulnerable to using formula feeds. Health workers provide counseling to almost all mothers for starting breastfeeding within 1 hour of birth and exclusive breastfeeding for at least 6 months.
However, it is quite common to see powdered formula milk by the bedsides of recently delivered mothers in hospitals or at home especially if she has undergone an operation to deliver the baby, or if she is a working mother or mother having breast problems or when the baby is unable to suck directly from the breast.
Globally, 42 % of mothers breastfeed within the first hour of life and only 41% exclusively breastfeed their babies for the initial six months. Had it been possible to provide mother’s milk or donated breast milk to the babies, nearly 12 % of the under-5 child deaths worldwide could have been averted by preventing them from possible gastrointestinal, respiratory, and other health problems.
Recently, new products claiming to replicate mother’s milk have entered the lucrative market of infant formula and such powerful marketing can exploit the gaps created due to inadequate societal support for breastfeeding. It is high time that more human milk banks are established worldwide to save more children from various short and long-term harms of breastfeeding deprivation.
Human Milk Bank: The need in our context
The use of donated breast milk dates back to our ancient culture and throughout history, Nepalese mothers have breastfed infants who were not their own. In Nepal, institutional deliveries increased from 8% in 1996 to 57% in 2016. Similarly, the population-based CS rates increased by 10-fold from 0.9% to 10.2% during the same period. Presently, around 81000 babies are born preterm in Nepal and contribute to 33% of the neonatal mortality followed by birth asphyxia and neonatal sepsis which account for 23% and 17 % of neonatal deaths respectively.
Babies born via Caesarean sections, born preterm, or needing admissions for infections and other problems are mainly given artificial feeds. In our context, donor milk can be a bridge to successful breastfeeding when a new mother may be facing challenges in establishing her milk supply. Donor milk can be life-saving for preterms, especially protective against a life-threatening condition called necrotizing enterocolitis, which affects 1 in 10 small preterm babies. Human milk is estimated to lower this condition by 79%.
Currently, only 18% of the babies are breastfed within the first hour of life as recommended and 66 % are exclusively breastfed for six months. All these factors necessitate the establishment of a human milk bank in our setup to ensure basic nutrition for newborns and children.
Paropakar Maternity & women’s Hospital –as a center for the new initiative
The presence of a milk bank in a hospital or neonatal intensive care unit (NICU), increases women’s and communities’ awareness of the importance of breastfeeding and subsequently improves breastfeeding practices and rates. Established in 1959, Paropakar Maternity and Women’s Hospital is the nation’s major wing providing quality maternal and newborn care services to around 24000 deliveries and up to 2000 sick newborns per annum.
In Paropakar, the average CS per day is 20 to 35, and the major burden of the newborn unit is occupied by preterm, low birth weight, and babies with neonatal sepsis, who are formula-fed in the absence of breast milk. All these factors necessitate the establishment of a human milk bank in our hospital to provide optimal newborn care.
We need to encourage lactating mothers to continue breastfeeding and donate a few ounces of their breastmilk to milk banks so that thousands of babies can have the best nourishment through breastmilk. The tedious process of collecting, donating, and storing, can be truly exemplary and rewarding for us as in the future it can save the lives of vulnerable babies.
Thus, we can ensure the best start for every baby including the small and sick newborns admitted to our hospital and other centers. This is in turn a vital step to achieve the Sustainable Developmental Goal (SDG) target of reduction in neonatal mortality rate and under 5 mortality rate to less than 12 per 1000 live births and 22 per 1000 live births respectively by 2030. So, with the following vision, and objectives we set up and started a human milk bank, the nation’s first human milk bank. And it will be a milestone in strengthening newborn care in Nepal.