Human Milk Banking Association
of North America
Position Paper on Donor Milk Banking
The Value of Human Milk
Human milk is the standard food for infants and young children including
premature and sick newborns with rare exceptions.(1,2)
Human milk provides optimal nutrition, promotes normal growth and
development, and reduces the risk of illness and disease.(3)
The unique composition of human milk includes nutrients, enzymes,
growth factors, hormones, and immunological and anti-inflammatory
properties that have not been duplicated.(4)
Exclusive breastfeeding for six months is recommended with introduction
of complementary nutritionally adequate foods at about this time. Optimally
breast milk remains in the diet for two years and beyond.(1)
In situations where mothers’ own milk is not available, provision of
pasteurized, screened donor milk is the next best option particularly for ill,
or high-risk infants.(5)
Current research regarding human milk
Human milk is species specific and provides unique benefits.(4) These
include health, nutritional, immunological, developmental, social, economic
and environmental benefits(2). The health benefits including long term
decreased risk of a wide range of illnesses and infections last beyond
infancy.(6,7,8)
Feeding human milk results in both short and long term health care cost
savings.(9,10,11,12,13)
Current research regarding pasteurized donor milk
Most bioactive properties found in human milk remain viable after
pasteurization.(14,15)
Pasteurized donor milk for premature and high risk infants has been
shown to reduce the incidence of necrotizing enterocolitis, sepsis, and
infection, resulting in shorter hospital stays.(13,16,17,18,19)
Donor milk has been reported to be effective for nutritional uses, post
surgical treatment and provision of immunological benefits. Patients with
varied comditions including bowel surgery (oomphalocele, gastroschisis),
failure to thrive, formula intolerance, suppressed IgA levels (treated post
liver transplantation), allergies, chronic renal failure, leukemia, intractable
pneumonia, and HIV have responded positively to the use of donor milk.
(20,21,22,23,24,25,26,27,28)
In order to provide a safe product and maintain the maximum active
beneficial components, processing and dispensing should be done in
accordance with the Guidelines from the Human Milk Banking Association
of North America.(29)
The rights of mothers and infants
Every mother has the right to information on the benefits of human milk,
both maternal and banked pasteurized donor milk.(30)
Every mother has the right to information on the risks of infant formula
including contamination, possible errors and omissions in composition,
importance of careful handling, preparation and storage and the associated
costs of use.
Every mother has the right make an informed choice about infant feeding
and have her choice respected and supported.
Every infant has the right to access banked pasteurized donor milk when
maternal milk is unavailable.
Every infant has the right to the highest attainable standard of health.(30)
Availability of pasteurized donor milk
Donor milk banks should be established in states/provinces/territories or
geographic regions depending on population in order to meet the needs of
North American children, particularly those who are at high risk (ill or
premature) when maternal milk is unavailable.
Establishing additional donor milk banks provides accessibility to and
availability of donor milk for families and is a safe, ethical and cost
effective method of encouraging optimal health.
Therefore health professionals are encouraged
To advocate for:
- The establishment of donor milk banks in their state/province/territory/
region.
- Information to enable mothers to make informed choices.
- Mothers’ informed choices to be supported and respected.
- Human milk to be respected for its value.
- Implementation of the Baby-Friendly Initiative and the International
Code of Marketing of Breast Milk Substitutes.
- Third party payment for donor milk processing fees.
In practice to:
- Use evidence based care and be familiar with the literature on the
benefits of human milk, donor milk banking, and the risks of formula
feeding.
- Provide education using non proprietary information and counseling
about all infant feeding choices and skilled help to support
breastfeeding.
- Ensure mothers make informed choices about infant feeding and are
supported in those choices.
- Provide information on the risks of using non screened donor milk.
To undertake research on:
- Optimal storage and handling of human milk, including processing of
donor milk.
- Benefits and cost savings of using donor milk.
- Donor milk; submitting case reports and other relevant information for
publication.
To provide leadership through:
- Partnership and collaboration to influence change in the health care
system.
- Encouragement of development of agency policies in support of the
use of donor milk.
References
- WHO resolution 54.2, May 18, 2001.
- American Academy of Pediatrics. Breastfeeding and the use of human
milk. Pediatrics, 1997; 100: 1035-1038.
- Picciano, M. F. (2001). Nutrient composition of human milk. Pediatric
Clinics of North America, 48. 1, 53-67.
- Hamosh, M. (2001). Bioactive factors in human milk. Pediatric Clinics
of North America, 48. 1, 69-86.
- WHO/UNICEF Joint statement: meeting on infant and young child
feedings. (1980). J Nur Midwife, 25, 31.
- Hanson, L.A. (1999). Human milk and host defense: immediate and
long-term effects. Acta Paediatr, 88, 42-46.
- Davies, M. (2001). Breastfeeding and chronic disease in childhood and
adolescence. Pediatric Clinics of North America, 48, 1, 125141.
- Singhal, A., Cole, T., J., Lucas, A. Early nutrition in preterm infants and
later blood pressure: two cohorts after randomized trials. Lancet, 2001;
357:413-419.
- Ball, T.M., Wright, A.L. (1999). Health care costs of formula-feeding in
the first year of life. Pediatrics, 103, 4, 870-876.
- Riordan (1997). The cost of not breastfeeding. A commentary. JHL, 13,
2, 93-97.
- Arnold, L.D. (1998). Cost savings through the use of donor milk: case
histories . JHL,14, 3, 255-258.
- Arnold, L.D. (2002). The cost-effectiveness of using banked donor milk
in the neonatal intensive care unit: prevention of necrotizing enterocolitis.
JHL, 18, 2, 172-177.
- Wright, N. (2001). Donor human milk for preterm infants. J. of
Perinatology, 21, 1-6.
- Tully, D., Jones, F., Tully, M.R. (2001). Donor milk: what’s in it and
what’s not. JHL, 17, 2, 152-155.
- Wallingford, J. Effects of pasteurization on anti-infective agents and
other proponents of human milk. Presentation at the HMBANA Annual
Conference; 1989.
- Lucas, A., Morley, R., Cole, T.J., Gore, S.M. (1994). A randomized
multicentre study of human milk versus formula and later development
in preterm infants. Archives of Disease in Childhood, 70, f, 141-146.
- Naranyanan, I., Prakashil, K., Bela, S., Verna, R.K., Gujral, W. (1980).
Partial supplementation with expressed breast-milk for prevention of
infection in low-birth-weight infants. Lancet, 13, 11, 561-563.
- Naranyanan, I., Prakashil, K., Gujral, W. (1981). The value of human
milk in the prevention of infection in the high-risk low-birth-weight
infant. J. Pediatr., 99, 3, 496-498.
- Naranyanan, I., Prakashil, K., Murphy, N.S. et al. (1984). Randomized
controlled trial of affect of raw and holder pasteurized human milk and
formula supplements on the incidence of neonatal infection. Lancet, ii,
8412, 111-1113.
- Arnold, L.D. (1990). Clinical uses of donor milk. JHL, 6, 3, 132-133.
- Arnold, L.D. (1993b). Human milk for premature infants: an important
health issue. JHL, 9, 2, 121-123.
- Arnold, L.D. (1995c). Use of donor milk in the treatment of metabolic
disorders: glycolytic pathway defects. JHL, 11, 1, 51-53.
- Arnold, L.D. (1995b). Use of donor milk in the management of failure to
thrive: case histories. JHL, 11, 2, 137-140.
- Asquith, M.T. Pedrotti, P., Stevenson, D., Sunshine, P. (1987). Clinical
uses, collection, and banking of human milk. Clinics in Perinatology,
14, 1, 173-185.
- Merhav, J., Wright, I., Mieles, A., Van Theil, D. (1995). Treatment of IgA
deficiency in liver transplants with human breast milk. Trans Int, 8, 4,
327-329.
- Ridell, D.G. (1989, October). Use of banked milk for feeding infants
with abdominal wall defects. Presentation. Annual HMBANA meeting.
Vancouver, B.C.
- Tully, M.R. (1990). Banked human milk in the treatment of IgA
deficiency and allergy sypmptoms. JHL, 6, 2, 75-77.
- Wiggins, P.K. Arnold, L.D. (1998). Clinical case history: donor milk use
for severe gastroesophageal reflux in an adult. JHL, 14, 2, 157-159.
- Human Milk Banking Association of North America (HMBANA, 2000 ).
Guidelines for the establishment and operation of a human donor milk
bank Denver; Author.
- United Nations. (1989). Convention on the Rights of the Child. Human
Rights Directorate, Department of Canadian Heritage. Quebec.
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