What about milk banks?

Eats On Feets respects the lactating woman’s right to determine the most appropriate use for her breastmilk. We also honor every baby’s right to human milk.1

The benefit of using donor milk from milk banks, when and if it can be obtained, is that the milk has been stringently screened for bacteria and infectious disease, pre- and post-pasteurization.

There are, however, always risks associated with feeding a baby anything other than his/her own mother’s healthy breastmilk via direct nursing, especially to those in the hospital. When considering donor milk, parents are balancing the benefits of superior nutrition and immunity against the risk of disease transmission. Even after donor milk is screened, some argue that pathogens can still remain2 in the milk, and after donor milk has been pasteurized, pathogens can (re-)contaminate milk. Please see ‘Are there risks to using donor milk?’ for more information.

Self-exclusion
A possible risk of milk from milk banks is that there is no control of exposure to non-infectious contaminants. Milk banks rely on self-exclusion of donors to keep milk free of tobacco, alcohol, medications, etc. There is no donor/recipient relationship when pursuing milk from milk banks. Getting to know a donor personally is an important aspect of informed milk sharing.

Raw versus pasteurized milk
Most milk from milk banks is given to hospitals for premature and sick babies.3 Sick and premature babies are at risk for neonatal hospital acquired infections. The lack of anti-effective properties in pasteurized milk can put a baby at risk, especially when a baby is sick or premature. Please see the section ‘What about premature babies?’ for more information.

In this previous but valuable study on the effect of routine screening of raw mother’s milk and donor milk for premature babies, the authors discuss that while the data clearly document that premature infants fed raw expressed human milk are frequently exposed to large numbers of bacteria, no adverse events directly related to consuming this milk were documented.

Please see ‘Why breastmilk?’ for more information on the benefits of (raw) breastmilk for all babies.

Risk from handling
Some of the risks of donor milk are associated with the methods that are used when feeding the expressed breastmilk to a baby.4 There have been documented cases in hospitals where newborns developed bacterial infections after receiving milk obtained from milk banks and delivered via feeding tubes or artificial nipples. For instance, “one outbreak of F. meningosepticum was not from milk, but was located on milk bottle stoppers and ‘cleaned’ teats, as well as the ward environment.” La Trobe Table #5 identifies four related deaths as a result of contaminated breastmilk in hospitals. Some of these infections appear to have been associated with a single donor, which indicates that there was some cross contamination that occurred with that particular batch of donor milk. The infections linked to contaminated breastmilk were generally caused by normal bacteria that live on human skin and are by definition not isolated to babies in hospitals. Sick and premature infants are more at risk for these infections. Please see ‘Handling of breastmilk’ for more information on proper handling techniques.

Another potential risk of milk from milk banks is that there is no control of exposure to non-infectious contaminants. Milk banks rely on self-exclusion of donors to keep milk free of tobacco, alcohol, medications, etc.

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Please also know that in the US per HMBANA guidelines, donors must be “willing to donate at least 100 ounces of milk; some banks have a higher minimum.” Other countries may have different requirements.

For the purpose of making informed choices, we encourage donors (as well as recipients) to research their options, to investigate milk bank procedures regarding heat-treatment,5 storage,6 distribution7 and usage,8 and to weigh the pros and cons of donating milk to a milk bank or to an individual.

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  1. In ‘Global Strategy for Infant and Young Child Feeding, bullet 10, p. 14, the WHO states: “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.” []
  2. Screening tests are designed to have a relatively high incidence of false positives in order to prevent any false negatives. While false positives happen to many people, pregnant or recently pregnant women tend to get them more frequently. From the perspective of a milk bank which will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor. This study does not follow up on the actual serological status of these women but, even per the most optimistic values, it is quite likely that many of these women did not in fact have any current infections. []
  3. HMBANA states: “In the US if a [milk] bank has difficulty meeting the demands of one of their client hospitals they are able to refer them to another non-profit milk bank, but this does not happen very often. The [milk] banks also serve many infants in the home who need milk because of medical conditions such as intolerance to breastmilk substitutes or feeding issues related to prematurity (see HMBANA FAQ: Why use donor milk?). When possible the [milk] banks serve healthy babies who have been adopted or are not able to get their own mother’s milk.” []
  4. The same potential infections can occur when breastmilk substitutes are used in the same setting. []
  5. Milk banks most commonly use the Holder Method as heat-treatment. See this La Trobe table for the effects of the various heat treatment and storage techniques on breastmilk. []
  6. BPNI writes: “The American milk bank guidelines give clear recommendations regarding these practical issues. Fresh-raw milk must be stored continually at 4 degrees Celsius for no longer that 72 hours following expression, whereas fresh-frozen milk can be held at 20 degrees Celsius for 12 months. Pasteurized milk may be stored under the same conditions as fresh milk.
    The method of transportation varies from shipping milk in commercial airlines that donate their cargo space, to refrigerated vans (as for blood products) or local volunteers driving their own vehicles.
    In France, however, one center freeze-dries the milk (a previously frozen liquid is dried under vacuum) increasing its storage duration at room temperature to eighteen months. This technique is not used in other counties for a number of reasons: loss of calcium and phosphorous, cost and possibly inaccurate reconstitution methods.” and “Unless the milk being stored is for a mother’s own infant, banked milk is then pooled. […] It is thought to be beneficial because it averages out the immunological and nutrient content of the milk. The numbers are kept low so that any contamination can theoretically be traced back to its source. In Germany, however, pooling is not used because of the concern regarding contamination.” []
  7. Not everyone who needs breastmilk will necessarily be able to obtain breastmilk from a milk bank. Please see this information from the FDA and this information from the Utah Breastfeeding Coalition about the priorities of milk banks in the US. []
  8. Donors should know that some milk banks serve for-profit companies. []

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