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COVID-19 or CORONAVIRUS

Human Milk Banking and SARS CoV-2 update. 12 March 2021
Prof Anna Coutsoudis & Dr Penny Reimers

COVID-19: Breastfeeding and human milk banking

Please note: This information is accurate as of today but new information about COVID-19 transmission is emerging daily. Please consult resources such as the CDC and the WHO for the most recent guidance.

Breastfeeding

Breast milk is the optimum source of nutrition for babies, yet the emergence of COVID-19, caused by the novel coronavirus SARS has raised questions both about the safety of breastfeeding and human milk banking.

Although there is much unknown about COVID-19, the recommendations below, sourced from the Center for Disease Control and Preventions (CDC) in the USA,  The World Health Organisation, UNICEF, the Human Milk Banking Association of North America (HMBANA), the European Milk Bank Association and the Academy of Breastfeeding Medicine (AMB) all agree breastfeeding should be continued.

According to the CDC, to date the virus has not been isolated in the breastmilk of infected women. Neither is there evidence at this stage, that the virus can be transmitted through breastmilk. Although the virus was not found in the breastmilk of infected women, antibodies against SARS-CoV were detected in one sample.(Center for Disease Control and Prevention [CDC], 2020)

Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed. UNICEF too are encouraging mothers infected with COVID-19 to continue breastfeeding while taking precautions which include wearing a mask when feeding or near the baby, frequent hand washing before and after handling the baby and disinfecting all surfaces. These practice careful  practices should continue for at least 5-7 days until cough and respiratory secretions are dramatically improved.Should the mother be too ill to breastfeed, expressed breastmilk can be fed to the baby. (UNICEF,2020).

No evidence of the virus was found in breastmilk, cord blood, amniotic fluid or throat swabs of newborns whose mothers had tested positive for the virus (Chen et al., 2020).

Editor-in-Chief of Breastfeeding MedicineArthur Eidelmanstates: “Given the reality that mothers infected with coronavirus have probably already colonized their nursing infant, continued breastfeeding has the potential of transmitting protective maternal antibodies to the infant via the breast milk. Thus, breastfeeding should be continued with the mother carefully practicing handwashing and wearing a mask while nursing, to minimize additional viral exposure to the infant” (Liebert, 2020).

https://www.bfmed.org/abm-statement-coronavirus

ACADEMY OF BREASTFEEDING MEDICINE STATEMENT ON CORONAVIRUS 2019 (COVID-19)

IN HOSPITAL

The choice to breastfeed is the mother’s and families.

If the mother is well and has only been exposed or is a PUI with mild symptoms, breastfeeding is a very reasonable choice and diminishing the risk of exposing the infant to maternal respiratory secretions with use of a mask, gown and careful handwashing is relatively easy.

If the mother has COVD-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness.

There are several choices in the hospital concerning housing for a breastfeeding mother and her infant.

  1. Rooming-in (mother and baby stay in the same room without any other patients in that room) with the infant kept in a bassinet 6 feet from the mother’s bed and taking precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, for direct contact with the infant and while feeding at the breast. Ideally, there should be another well adult who cares for the infant in the room.
  2. Temporary separation – primarily because the mother is sick with the COVID-19 infection and needs medical care for herself in the hospital. Mothers who intend to breastfeed / continue breastfeeding should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver.

Mothers and families may need additional guidance and support to continue breastfeeding, to utilize expressed breast milk, to maintain her milk production and to store milk for later use while the mother is sick with COVID-19.

Human Milk Banking

Human Milk Banks have numerous safety measures in place which ensure that every bottle of donor milk is safe. These included careful screening of potential donors as well as proven pasteurisation methods, which kill viruses and bacteria and microbiology testing of the milk.

Despite the fact that COVID-19 is a new virus and there is limited data about it, the similarities with SARS and MERS are pertinent and can be applied to milk banking namely, that these viruses are inactivated by Holder pasteurisation (62.5° C for 30 minutes.

Notwithstanding this HMBASA proposes additional screening questions be added to the current lifestyle/health questionnaire:

  • Have you travelled through or stayed in a high-risk area during the past 14 days?
  • Have you been in close contact with any confirmed or suspected case of Covid-19?
  • Have you attended a facility where a positive case of Covid-19 has been confirmed?

If any responses are positive, these donors should be suspended for 14 days. Should any donor mothers become ill with signs of a respiratory infection the milk banks should be notified immediately (EMBA,2020).

References:

  1. Center for Disease Control and Prevention (CDC). (2020). Interim guidance on breastfeeding for a mother confirmed or under investigation for COVID-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidancebreastfeeding.html
  2. UNICEF. Coronavirus disease: What parents should know. Available at: https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know
  3. Chen, H., Guo, J., Wang, C., Luo, F. L., Yu, X., Zhang, W., Li, W, et al. (2020) Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: A retrospective review of medical records. The Lancet. Advanced online publication. DOI:10.1016/S0140-6736(20)30360-3
  4. Liebert, M.L. Coronavirus treatment and risk to breastfeeding women. Available at: https://eurekalert.org/pub_releases/2020-03/mali-cta030420.php
  5. European Human Milk Banking Association Covid-19: EMBA position statement. Available at : https://europeanmilkbanking.com/covid-19-emba-position-statement/
  6. Academy of Breastfeeding Medicine. ABM statement on corona virus 2019 (COVID-19). Available at :https://www.bfmed.org/abm-statement-coronavirus

Guidance on breastfeeding for mothers with confirmed COVID-19 or under investigation for COVID-19

Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.  A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.  If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.

Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.

For symptomatic mothers well enough to breastfeed, this includes wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.  

If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon – all while following the same infection prevention methods.

The virus spreads mainly from person to person by close contact (0-2 meters) and it is transmitted via respiratory droplets produced when an infected person sneezes or coughs. It may be possible that a person can get COVID-19 by touching a surface or object contaminated by infected respiratory secretions and then touching his or her own mouth, nose, or eyes, but, so far, this is not thought to be the main way the virus spreads. Infected people are thought to be most contagious when they are most symptomatic. However, as with other respiratory infections, some spread might be possible before symptoms appear.

This justifies all the precautions which are recommended by the health authorities in order to limit the transmission of the virus (http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19).

Regarding human milk donation:

Human milk is essential for premature infants, as it significantly reduces the risk of serious complications related to prematurity, in the short and long term.

Human milk donation is organized and supported by EMBA according to the common rules concerning the selection of donors based on a health questionnaire and on blood sampling as well as the handling and treatment of milk by pasteurisation, in accordance with the EMBA documents1,2.

Regarding breastmilk and SARS CoV-2:

It is not yet known whether SARS CoV-2 can be found in human milk, and if found, it could be contagious.

Other coronaviruses are destroyed by thermal inactivation3. In particular, MERS-coronavirus is inactivated in camel, goat and cow’s milk at 63°C for 30 min4. However, it should be pointed out that the few available studies simulated pasteurisation in small aliquots, a procedure that does not follow human milk bank protocols. Based on the available data on other coronaviruses it is likely that, even if SARS CoV-2 is present in breastmilk, it could also be destroyed by pasteurisation, but solid data is needed.

Taking into account the available information, EMBA recommends to add to the health questionnaires utilised to screen human milk donors, specific questions concerning the risk of being a suspected or probable case (refer to the “Case” definition on the World Health Organization website: https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)).

For example:

  • Having stayed or transited in a risk zone during the previous 14 days
  • Close contact with a confirmed or probable case of SARS CoV-2 infection during its symptomatic phase
  • Person who worked in or attended a health care facility in which a case of SARS CoV-2 infection has been confirmed.

This makes it possible to temporarily suspend the recruitment of these mothers for 2 weeks, in order to ensure that they do not become ill during this period of time.

If an already established donor develops signs of possible SARS-CoV2 infection (severe acute respiratory infection: cough, fever, sore throat etc.) with no other etiology that fully explains the clinical presentation, and/or reports a risk exposure in the 14 days preceding the milk donation,  a rhinopharyngeal swab is recommended. Donation should be temporary discontinued until the result of the swab. If the culture is positive for SARS CoV-2, donation should be interrupted until a negative culture is found. If the culture is negative for SARS CoV-2, donation can be continued.

Regarding hygiene in human milk banks

EMBA recommends strict observation of the hygienic rules regarding collection, storage and handling of donated human milk1.

References

  1. Weaver G et al. Recommendations for the Establishment and Operation of Human Milk Banks in Europe: A Consensus Statement From the European Milk Bank Association (EMBA). Front. Pediatr. 7:53 (2019).
  2. Moro GE et al. Processing of Donor Human Milk: Update and Recommendations From the European Milk Bank Association (EMBA). Front. Pediatr. 7:49 (2019).
  3. Duan SM et al. Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. Biomed Environ Sci. 16(3):246-55 (2003).

van Doremalen N et al. Stability of Middle East Respiratory Syndrome Coronavirus in Milk. Emerg Infect Dis. 20(7):1263-1264 (2014).

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Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care

Background

In an effort to prevent infants being infected with SARS-CoV-2, some governments, professional organisations, and health facilities are instituting policies that isolate newborns from their mothers and otherwise prevent or impede breastfeeding. Click to read further

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Donor Human Milk Banking—Time to Redirect the Focus?

Donor Human Milk Banking—Time to Redirect the Focus?

Journal of Human Lactation 00(0) 1–5 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0890334420941805 journals.sagepub.com/home/jhl

Penny Reimers, PhD, IBCLC1 

and Anna Coutsoudis, PhD1

breastfeeding, breastfeeding support, milk banking, mother-infant dyad, very low birth weight

Background

The growth of donor milk banking, globally, has reduced infant morbidity and mortality, providing life-saving human milk for the most vulnerable infants (Bertino et al., 2013; Kim et al., 2017). The World Health Organisation (2016) has advocated for its use where mother’s milk is temporarily unavailable. Since researchers have estab- lished the benefits of using donor milk in very low birth- weight infants, demand for donor human milk has increased rapidly (Human Milk Banking Association of North America, 2020).

The current COVID-19 pandemic has resulted in con- cerns over maintaining the supply of donor milk (Marinelli, 2020). China’s public health documents have recom- mended the separation of an infected mother and her infant, despite no evidence of risk of transmission via breastfeeding (National Health Commission of the People’s Republic of China, 2020). Stuebe (2020) contended that the separation of the mother/infant dyad, and depriving the infant of the mother’s milk, poses significant risks to both. Other challenges faced by milk banks include a reduced number of donor mothers due to screening and collection difficulties, and maintaining adequate numbers of staff, all of which increase pressure on the provision of donor milk (Shenker, 2020).

To date, around 600 donor human milk banks (DHMB) in many countries operate with dedicated people working tire- lessly to raise awareness and feed the most vulnerable infants (Israel-Ballard et al., 2019). Globally, around 800,000 infants are being fed donor milk annually (Shenker, 2020). Community DHMBs also provide a valuable service, feed- ing vulnerable infants. The first community-based bank was established in South Africa 20 years ago, and has witnessed substantial improvements in the condition of HIV-infected orphans fed with donor human milk (Reimers et al., 2018). The Hearts Milk Bank in the United Kingdom, in addition to providing donor milk to hospitals, also supports mothers in the community who are temporarily unable to breastfeed

their infants. Women experiencing health issues or having chemotherapy have been given donor milk to enable them to continue feeding their infants (Hearts Milk Bank, 2020).

Strides have been made in developing guidelines and pro- tocols to ensure a safer product. PATH (2019), a global NGO, has developed an extensive toolkit for the establishment of human milk banks. However, there is no differentiation between guidelines for developed and developing countries.

Donor human milk banking is inextricably linked to pro- moting, protecting, and supporting breastfeeding. Multiple researchers have shown an improvement in breastfeeding rates where donor milk is administered (Adhisivam et al., 2017; Kantorowska et al., 2016). A systematic review con- ducted by Williams et al. (2016) showed there was a positive impact on any breastfeeding rates upon discharge, but not upon exclusive breastfeeding (EBF) or the exclusive admin- istration of mother’s own milk. A single study center, included in their review, reported a significant decrease in the percentage of feeds, which were mothers’ own milk, after donor milk was introduced (Williams et al., 2016). It is important to note that the authors confirmed the lack of high- quality data when conducting this review, with only 10 stud- ies meeting their inclusion criteria. Six (60%) of the studies included were from the United States. Four (25%) of the studies were from conference abstracts, so had not been peer reviewed, and eight (80%) were retrospective, with a high risk of bias. It is problematic to measure breastfeeding rates at discharge from an neonatal intensive care unit (NICU), and given that few donor milk banks do this, it is difficult to ascertain what the true situation is.

1Department of Child Health and Paediatrics, University of KwaZulu- Natal, Durban, South Africa

Date submitted: April 14, 2020; Date accepted: June 19, 2020.

Corresponding Author:

Penny Reimers, PhD, IBCLC, Department of Child Health and Paediatrics, University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa. Email: pennyreimers@outlook.com

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Data about rates of breastfeeding at discharge from NICUs, it appears, is not routinely collected, as is reflected in surveys conducted in Italy (De Nisi et al., 2015), China (Liu et al., 2019), and India (Sachdeva et al., 2019). While some toolkits for setting up a human milk bank provide a wealth of information on breastfeeding support (PATH, 2019), others, like in the United Kingdom (National Institute for Health and Clinical Excellence, 2010) and the European Milk Banking Association, focus on the operations of the milk bank, without specifically mentioning supporting breastfeed- ing (European Foundation for the care of newborn infants, 2018; Weaver et al., 2019). Brazil’s extensive networks of human milk banks are also known as Breastfeeding Promotion Centers. In addition to collecting and processing donor milk, they provide lactation support, as do many trained lay people in the community (Schreiber, 2018).

Our premise is that in the developing world high infant mor- tality rates (IMR) suggest that the benefits of promoting and supporting breastfeeding far outweigh the benefits of establish- ing expensive donor milk banks. One cannot downplay the greater value of investing in breastfeeding support, the benefits of which have long-term health consequences and influence infant and maternal morbidity and mortality. In the quest to establish milk banks and provide donor milk to vulnerable infants, the focus on short-term goals has often obscured the long-term vision of meeting infants’ nutritional needs after dis- charge. The significance of supporting breastfeeding more intentionally, and allocating resources appropriately, especially in developing countries, will improve infant survival and long- term health outcomes.

Measuring Success

As we look back over the past 20 years, how do we measure success in human milk banking? Is it to have recruited more donor mothers every year? Is it to have pasteurized more liters of human milk? Is it to have fed more infants with donor milk? Is it to have opened more milk banks? Wheatley and Kellner-Rogers (1999) challenged us to think, “Are we measuring what is meaningful? Should we rather let the greater meaning of the work define what we measure?” (p. 3). Is the greater meaning of the work of donor milk banks to ensure that infants have access to optimum nutrition long after discharge from a NICU?

The benefits of donor milk in reducing the risk of necro- tising enterocolitis (NEC) and reducing the risk of late onset sepsis are well established. (Quigley et al., 2019). The short- term benefits of having access to donor milk are indisput- able. The danger is that reaching for the donor milk may become the default or easier option, instead of the more time-consuming intervention of supporting mothers to express in those early difficult days. Donor milk should always be viewed as a short-term intervention or bridge, never losing sight of the invaluable resource of mother’s

own milk. An example of this is the Banco de Leche in the Roosevelt Hospital in Guatemala City which provides all infants up to the age of 33 weeks with donor milk, after which they are given preterm formula (Paynter & Celis- Hecht Mendoza, 2019). All mothers are asked to donate milk, and the majority do. Only once every weekday, moth- ers come to a pumping room in the hospital where they pump milk for all the infants in the NICU. Many only express a few milliliters at a time and can take a week to fill the 120 ml container. It is admirable that they have a NEC rate of less than 1%, but it is concerning that these mothers very possi- bly will not have established sufficient supply to continue to provide milk for their infants after discharge (Paynter & Celis-Hecht Mendoza, 2019).

We believe there has been too much emphasis on the commercialization of donor human milk. Australia has one milk bank making a shelf-stable, freeze-dried donor milk product for the public (Jacques, 2020) while, in the United States, for-profit human milk banks are making a range of human milk nutritional products (Prolacta, 2020). There have also been reports of women in low-resource settings being paid for their milk, which was shipped to first world countries and sold, placing the donors’ infants at risk (Wong, 2017).

Resetting

Do we need to stop, reset, and get back to basics? Should we not rather be supporting every woman to initiate and provide her own milk, which is so perfectly suited for her own infant, and superior to donor milk? Pasteurization unfortunately results in the loss of some valuable immune and microbiome boosting properties. Wilson et al. (2015) reported a link to the early expressing of human milk in mothers of very preterm infants as a predictor of a higher milk yield at Day 3 and Day 7. This early expressing was also a predictor of EBF at 3 weeks. This demonstrates how critical it is to support

Key Messages

  • Donor human milk provides a life-saving, short- term intervention when mother’s own milk is temporarily unavailable.
  • Supporting breastfeeding to ensure a mother increases her supply to take over the provision of milk for her own infant is critical.
  • Investing in breastfeeding support has long-term health consequences for both the mother and infant.
  • Safe and sustainable models for establishing donor milk banks that are feasible in low resource settings are necessary.

Reimers and Coutsoudis

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these mothers to supply their own milk in the first week after delivery, to ensure a long-term supply.

The Global Breastfeeding Collective (WHO/UNICEF, 2017), in their document on an investment case for breast- feeding, highlighted the fact that breastfeeding is one of the best investments for global health. The World Health Assembly’s (2017) target is to increase the number of chil- dren EBF to 50% by 2025, at a cost of just $4.70 per child. The economic gains generated by improving child survival and cognitive development would be around $300 bil- lion—a very worthwhile investment with a return of 5.2% (WHO/UNICEF, 2017). The Lancet Breastfeeding series highlighted how critical breastfeeding is for both the short- and long-term health of mothers and their infants. Despite this, in most countries around the world women are not receiving the support they require both to initiate and sus- tain breastfeeding (Victora et al., 2016). There is much work still required to remove structural and societal barri- ers to breastfeeding: Maternity and workplace policies supportive of breastfeeding are needed, and restricting the marketing of human milk substitutes also is essential (Rollins et al., 2016).

We call for limited valuable resources to be directed towards supporting breastfeeding within the donor milk bank environment. Donor human milk banks are merely one strategy for protecting, promoting, and supporting breast- feeding, and should form part of a nations’ national breast- feeding policy. Safeguards are needed to ensure that funds are not prioritized for donor milk banks at the expense of other strategies.

Are the strides to get a global donor milk bank standard of “one size fits all,” including expensive equipment, necessary for developing countries? Would investment in breastfeeding support and innovative ways to set up milk banks simply but safely not be more beneficial? This would guarantee an equi- table distribution of milk banks where they are needed most and, critically, would provide much needed breastfeeding support. The global community has a responsibility to ensure that developing countries are not pressured to aspire to repli- cate the technologically-advanced processes of the West, to the detriment of their health and scarce resources. Systems for donor milk banks need to be contextually appropriate, safe, and sustainable in order to provide a solution which will improve the lives of mothers and their infants.

Dr. Peter McCormick, a volunteer Pediatric oncologist and founder of the Beryl Thyer Memorial Africa Trust, worked in Cameroon for many years. He set up five simple milk banks to meet the needs of vulnerable infants. He said, “This is a worthwhile low-cost, low technology, small scale, life-saving project, tailored to the need of a resource-poor world” (Arnold, 2010, p. 374). He demonstrated that expen- sive technical apparatus and processes are not necessary to successfully run a HMB. Supporting breastfeeding was an integral part of his model. A number of low-cost, mobile pas- teurization systems have also been developed in South Africa

for use in resource constrained settings, and are being used safely and successfully—in both rural and urban hospital set- tings alike—in Africa, Asia, and New Zealand (Daniels et al., 2018; Naicker et al., 2015).

Conclusion

The commitment to setting up donor milk banks needs to be harnessed to ensure the focus includes critical breast- feeding support, so countries looking to set up milk banks make it an integral part of their planning and operation. By providing safe and sustainable models for establishing donor milk banks, which are feasible for low-resource set- tings, we are making this valuable resource a possibility to many more vulnerable infants, globally. At the same time we are ensuring mothers’ own milk is prioritized both in the short- and longer-term. As Frans Kafka said, “There are some things one can only achieve by a deliberate leap in the opposite direction.” Is it time, and are we brave enough to stop and leap towards supporting breastfeeding more intentionally?

Declaration of Conflicting Interests

The authors acknowledge that their experience in donor milk banking has been in developing countries but have had frequent international exposure and interactions working with various groups on donor milk banking. The authors are both founder and board members of the Human Milking Banking Association of South Africa and are members of the Global Virtual Collaborative Network of Human Milk Banks and Associations. They serve in an advisory capacity to a community-based milk bank in South Africa, for which they are not remunerated.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Penny Reimers, PhD, IBCLC 6864-8477

References

https://orcid.org/0000-0001-

Adhisivam, B., Vishnu Bhat, B., Banupriya, N., Poorna, R., Plakka, N., & Palanive, C. (2017). Impact of human milk banking on neonatal mortality, necrotizing enterocolitis, and exclusive breastfeeding—Experience from a tertiary care teaching hospital, South India. Journal of Maternal and Fetal Neonatal Medicine1, 1–4.

Arnold, D. W. L. (2010). Human milk in the NICU: Policy into practice. Jones & Bartlett.

Bertino, E., Giuliani, F., Baricco, M., Di Nicola, P., Peila, C., Vassia, C., Chiale, F., Pirra, A., Cresi, F., Martano, C., & Coscia, A. (2013). Benefits of donor milk in the feeding of

4

Journal of Human Lactation 00(0)

page4image39896960

preterm infants. Early Human Development89(2), S3–S6. doi:

10.1016/j.earlhumdev.2013.07.008
Daniels, B., Reimers, P., King, T., Schmidt, S., & Coutsoudis, A.

(2018). Effect of the PiAstra benchtop flash-heating pasteurizer on immune factors of donor human milk. Breastfeeding Medicine13(4), 281–285. doi:10.1089/bfm.2018.0017

De Nisi, G., Moro, G. E., Arslanoglu, S., Ambruzzi, A. M., Biasini, A., Profeti, C., Tonetto, P., Bertino, E., & members of the Italian Association of Donor Human Milk Banks. (2015). Survey of Italian human milk banks. Journal of Human Lactation31(2), 294–300. doi:10.1177/0890334415573502

European Foundation for the Care of Newborn Infants. (2018). Toolkit for establishing and organising milk banks. https:// www.efcni.org/activities/projects/milk-banks/

Hearts Milk Bank. (2020). A very special story. https:// heartsmilkbank.org/a-very-special-baby/

Human Milk Banking Association of North America. (2020, March 31). Donor human milk increases by nearly 1 million ounces. https://www.hmbana.org/news/donor-human-milk-increases- by-nearly-1-million-ounces.html

Israel-Ballard, K., Cohen, J., Mansen, K., Parker, M., Engmann, C., Kelley, M., Brooks, E., Chatzixiros, E., Clark, D., Grummer- Strawn, L., Hartmann, B., Kennedy, S., Kent, G., Mwangome, M., Nyirenda, D., Perrin, M. T., Picaud, J.-C., Reimers, P., Roest, J., & Oxford-PATH Human Milk Working Group. (2019). Call to action for equitable access to human milk for vulnerable infants. The Lancet Global Health7(11), e1484–e1486. doi:10.1016/S2214-109X(19)30402-4

Jacques, O. (2020, March 24). Breastmilk available to every newborn thanks to new technology. ABC News. https:// www.abc.net.au/news/2020-03-24/powdered-breastmilk- technology-could-save-lives/12079406

Kantorowska, A., Wei, J. C., Cohen, R. S., Lawrence, R. A., Gould, J. B., & Lee, H. C. (2016). Impact of donor milk availability on breast milk use and necrotizing enterocolitis rates. Pediatrics137(3), e20153123. doi:10.1542/peds.2015-3123

Kim, E. J., Lee, N. M., & Chung, S.-H. (2017). A retrospective study on the effects of exclusive donor human milk feeding in a short period after birth on morbidity and growth of preterm infants during hospitalization. Medicine96(35), e7970. doi:10. 1097/MD.0000000000007970

Liu, X.-H., Han, S.-P., Wei, Q.-F., Zheng, F.-Y., Zhang, T., Chen, H.-M., Mao, M., & National Human Milk Bank Group, Children Health of the Chinese Medical Doctors Association, Group of Child Health Care, Society of Pediatrics, Chinese Medical Association. (2019). The data and characteristics of the human milk banks in mainland China. World Journal of Pediatrics15(2), 190–197. doi:10.1007/s12519-019-00226-6

Marinelli, K. A. (2020). International perspectives concerning donor milk banking during the SARS-CoV-2 (COVID-19) pandemic. Journal of Human Lactation00(0), 1-6, 089033442091766. doi:10.1177/0890334420917661

Naicker, M., Coutsoudis, A., Israel-Ballard, K., Chaudhri, R., Perin, N., & Mlisana, K. (2015). Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk

pasteurization in resource-limited settings. Breastfeeding

Medicine10(2), 107–112. doi:10.1089/bfm.2014.0125 National Health Commission of the People’s Republic of China. (2020). Notice on strengthening maternal disease treatment and safe midwifery during the prevention and control of new coronavirus pneumonia. https://www.nhc.gov.cn/xcs/ zhengcwj/202002/4f80657b346e4d6ba76e2cfc3888c630.shtml National Institute for Health and Clinical Excellence. (2010). Donor breast milk banks: The operation of donor milk bank services. https://www.nice.org.uk/guidance/cg93/evidence/

full-guideline-243964189
PATH. (2019). Strengthening human milk banking: A resource

toolkit for establishing and integrating human milk bank programs—A global implementation framework. https:// www.path.org/programs/maternal-newborn-child-health-and- nutrition/strengthening-human-milk-banking-resource-toolkit/

Paynter, M. J., & Celis-Hecht Mendoza, A. K. (2019). The Roosevelt Hospital Banco de Leche: Nonprofit human donor milk bank in Guatemala City. Journal of Human Lactation35(3), 563–568. doi:10.1177/0890334418807465

Prolacta. (2020). Bioscience. https://www.prolacta.com/
Quigley, M., Embleton, N. D., & McGuire, W. (2019). Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews7,

CD002971. doi:10.1002/14651858.CD002971.pub5
Reimers, P., Shenker, N., Weaver, G., & Coutsoudis, A. (2018). Using donor human milk to feed vulnerable term infants: A case series in KwaZulu natal, South Africa. International Breastfeeding Journal13, 43. doi:10.1186/s13006-018-0185-6 Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., Piwoz, E. G., Richter, L. M., Victora, C. G., & Lancet Breastfeeding Series Group. (2016). Why invest, and what it will take to improve breastfeeding practices? The Lancet,

387(10017), 491–504. doi:10.1016/S0140-6736(15)01044-2 Sachdeva, R. C., Mondkar, J., Shanbhag, S., Sinha, M. M., Khan, A., & Dasgupta, R. (2019). A landscape analysis of human milk banks in India. Indian Pediatrics56(8), 663–668. doi:10.1007/

s13312-019-1590-7
Schreiber, M. (2018, June 14). Brazil’s successful milk bank

system, which relies on donated milk, is now being adopted across Latin America. News Deeply. Malnutrition Deeply. https://www.newsdeeply.com/malnutrition/articles/2018/06/ 14/human-milk-banking-the-surprisingly-simple-way-to-save- babies-lives

Shenker, N., on behalf of the Virtual Collaborative Network of Human Milk Banks and Associations. (2020). Maintaining safety and service provision in human milk banking: A call to action in response to the COVID-19 pandemic. Lancet Child and Adolescent Health, 4, 484-485.. https://doi.org/10.1016/ S2352-4642(20)30134-6

Stuebe, A. (2020). Should infants be separated from mothers with COVID-19? First, do no harm. Breastfeeding Medicine15(5), 351–352. doi:10.1089/bfm.2020.29153.ams

Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N.,

Reimers and Coutsoudis

5

page5image40316544

Rollins, N. C., & Lancet Breastfeeding Series Group. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet387(10017), 475–490. doi:10. 1016/S0140-6736(15)01024-7

Weaver, G., Bertino, E., Gebauer, C., Grovslien, A., Mileusnic- Milenovic, R., Arslanoglu, S., Barnett, D., Boquien, C.-Y., Buffin, R., Gaya, A., Moro, G. E., Wesolowska, A., & Picaud, J.-C. (2019). Recommendations for the establishment and operation of human milk banks in Europe: A consensus statement from the European Milk Bank Association (EMBA). Frontiers in Pediatrics7, 7–23. doi:10.3389/fped. 2019.00053

Wheatley, M., & Kellner-Rogers, M. (1999). What to measure and why. Questions about the uses of measurement. Journal for Strategic Performance Measurement. https://www. margaretwheatley.com/articles/whymeasure.html

Williams, T., Nair, H., Simpson, J., & Embleton, N. (2016). Use of donor human milk and maternal breastfeeding rates: A

systematic review. Journal of Human Lactation32(2), 212–

220. doi:10.1177/0890334416632203
Wilson, E., Christensson, K., Brandt, L., Altman, M., &

Bonamy, A.-K. (2015). Early provision of mother’s own milk and other predictors of successful breast milk feeding after very preterm birth: A regional observational study. Journal of Human Lactation31(3), 393–400. doi:10.1177/08903344 15581164

Wong, T. (2017, March 23). Cambodia breast milk: The debate over mothers selling milk. BBC. https://www.bbc.co.uk/news/ world-asia-39414820

World Health Organisation. (2016). Donor human milk for low- birth-weight infants. http://www.who.int/elena/titles/full_ recommendations/feeding_lbw/en/Google Scholar

World Health Organization & UNICEF. (2017). Global Breastfeeding Collective: A call to action. https://www.who. int/nutrition/publications/infantfeeding/global-bf-collective- calltoaction/en/

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Articles & Publications

Milking It!

This report exposes the lack of scientific underpinning behind the products BMS manufacturers put on diferent markets. Manufacturers are constantly placing new formula products on the market with a variety of di erent claims. Often, they claim that their products are informed by the ‘latest developments in nutritional science’. However, the wide variety of products on sale within and between countries and the e orts of companies to push expensive premium products, especially to high-growth Asian markets, call such claims into question. Click To Read Report

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Busted!

“On the basis of this, the report concludes that Nestlé is not driven by nutritional science, but instead by a sharp and prioritised focus on profit and growth at the expense of infants and their parents. As two out of three babies currently rely on formula, either on its own or in combination with breastmilk and other foods, manufacturers of infant milks have a huge responsibility. They must ensure that their products are safe, fed only to the appropriate-aged infants, as nutritionally complete as possible and strictly informed by science.”
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Articles & Publications News

Formula Companies Targeting Poor Mothers

Trixia, 19, bottle feeds her four month-old daughter near her home in a deprived community in Navotas, Metro Manila, the Philippines. ————Photograph: Hanna Adcock/Save the Children ——————–

Formula milk companies are continuing to use aggressive, clandestine and often illegal methods to target mothers in the poorest parts of the world to encourage them to choose powdered milk over breastfeeding, a new investigation shows.

A Guardian/Save the Children investigation in some of the most deprived areas of the Philippines found that Nestlé and three other companies were offering doctors, midwives and local health workers free trips to lavish conferences, meals, tickets to shows and the cinema and even gambling chips, earning their loyalty. This is a clear violation of Philippine law. Click to read more.

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Articles & Publications News

To pay or not to pay?

Lactation Consultant Penny Reimers considers the ethics behind paying donor mothers for breast milk

In South Africa, paying mothers for breast milk is illegal. Because human milk is classified as a human tissue, it is governed by the Human Tissue Act, which prohibits payment for donating anything deemed to be human tissue. This includes a prohibition of women buying and selling breast milk informally on the internet. However, this is a hot topic internationally with the explosion of for-profit milk banks in the USA and the informal buying and selling of milk on the internet.

Click to read article: SMM OCT 2017 -To pay or not to pay – By Penny Reimers

Penny Reimers

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Articles & Publications

New World Health Organization guidance helps protect breastfeeding as a human right

Abstract

Written by the WHO/UNICEF NetCode author group, the comment focuses on the need to protect families from promotion of breast-milk substitutes and highlights new WHO Guidance on Ending Inappropriate Promotion of Foods for Infants and Young Children. The World Health Assembly welcomed this Guidance in 2016 and has called on all countries to adopt and implement the Guidance recommendations. NetCode, the Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and Subsequent Relevant World Health Assembly Resolutions, is led by the World Health Organization and the United Nations Children’s Fund. NetCode members include the International Baby Food Action Network, World Alliance for Breastfeeding Action, Helen Keller International, Save the Children, and the WHO Collaborating Center at Metropol University. The comment frames the issue as a human rights issue for women and children, as articulated by a statement from the United Nations Office of the High Commissioner for Human Rights.

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Articles & Publications Events

Report On The Human Milk Banking Workshop March 2016

Report on the Human Milk Banking Workshop
ISRHML Conference
Stellenbosch, South Africa
3rd of March 2016 9am-12pm

Human Milk Banking (HMB) was highlighted in a pre-conference workshop on the 3rd of March 2016 at the International Society of Research in Human Milk and Lactation (ISRHML) Conference. Held every two years, the conference was hosted this year for the first time African continent, in an effort to encourage a more global perspective and representation. It was also the first year to host an entire pre-conference workshop on Human Milk Banking, highlighting a trend seen throughout the conference to focus on public health research in addition lab-based research.

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The Global Launch of The Lancet Breastfeeding Series

The Lancet Breastfeeding Series is the first of its kind to evaluate global breastfeeding levels, trends and inequalities, in addition to the short- and long-term consequences for both mother and child, regardless of where they live or their income. The Series underscores the importance of policy interventions to increase and sustain breastfeeding levels. This interactive launch event will highlight key findings as well as present success stories and opportunities to eliminate barriers to breastfeeding in high- and low-income countries.

For information go to:

The Lancet Breastfeeding Series