Optimal Pooling, Batching, and Pasteurizing of Donor Human Milk

2021 ◽  
Author(s):  
Ruichen Sun ◽  
Lisa M. Maillart ◽  
Silviya Valeva ◽  
Andrew J. Schaefer ◽  
Shaina Starks
Keyword(s):  
Human Milk ◽  
Valid Inequalities ◽  
Standard Of Care ◽  
Human Breast Milk ◽  
North Texas ◽  
Donor Human Milk ◽  
Milk Bank ◽  
Pooling Strategies ◽  
Optimality Gap ◽  
Milk Banks

Human breast milk provides nutritional and medicinal benefits that are important to infants, particularly those who are premature or ill. Donor human milk, collected, processed, and dispensed via milk banks, is the standard of care for infants in need whose mothers cannot provide an adequate supply of milk. In this paper, we focus on streamlining donor human milk processing at nonprofit milk banks. On days that milk is processed, milk banks thaw frozen deposits, pool together milk from multiple donors to meet nutritional specifications of predefined milk types, bottle and divide the pools into batches, and pasteurize the batches using equipment with various degrees of labor requirements. Limitations in staffing and equipment and the need to follow strict healthcare protocols require productive, expedient, and frugal pooling strategies. We formulate integer programs that optimize the batching-pasteurizing decisions and the integrated pooling-batching-pasteurizing decisions by minimizing labor and meeting target production goals. We further strengthen these formulations by establishing valid inequalities for the integrated model. Numerical results demonstrate a reduction in the optimality gap through the strengthened formulation versus the basic integer programming formulation. A case study at Mothers’ Milk Bank of North Texas demonstrates significant improvement in meeting milk type production targets and a modest reduction in labor compared with former practice. The model is in use at Mothers’ Milk Bank of North Texas and has effectively improved their production balance across different milk types.

scholarly journals SARS-CoV-2 in human milk is inactivated by Holder pasteurization but not cold storage

2020 ◽  
Author(s):  
Gregory J. Walker ◽  
Vanessa Clifford ◽  
Nidhi Bansal ◽  
Alberto Ospina Stella ◽  
Stuart Turville ◽  
...  
Keyword(s):  
Viral Load ◽  
Human Milk ◽  
Cold Storage ◽  
Control Medium ◽  
Live Virus ◽  
Donor Human Milk ◽  
Milk Bank ◽  
The Stability ◽  
Milk Banks ◽  
Mother’S Own Milk

ABSTRACTAs the COVID-19 pandemic evolves, human milk banks worldwide continue to provide donor human milk to vulnerable infants who lack access to mother’s own milk. Under these circumstances, ensuring the safety of donor human milk is paramount, as the risk of vertical transmission of SARS-CoV-2 is not well understood. Here, we investigate the inactivation of SARS-CoV-2 in human milk by pasteurisation, and the stability of SARS-CoV-2 in human milk under cold storage (freezing or refrigeration). Following heating to 63°C or 56°C for 30 minutes, SARS-CoV-2 replication competent (i.e. live) virus was undetected in both human milk and the control medium. Cold storage of SARS-CoV-2 in human milk (either at 4°C or - 30°C) did not significantly impact infectious viral load over a 48 hour period. Our findings demonstrate that SARS-CoV-2 can be effectively inactivated by Holder pasteurisation, and confirm that existing milk bank processes will effectively mitigate the risk of transmission of SARS-COV-2 to vulnerable infants through pasteurised donor human milk.

Ebola Virus and Marburg Virus in Human Milk Are Inactivated by Holder Pasteurization

2017 ◽  
Vol 33 (2) ◽  
pp. 351-354 ◽  
Author(s):  
Erin Hamilton Spence ◽  
Monica Huff ◽  
Karen Shattuck ◽  
Amy Vickers ◽  
Nadezda Yun ◽  
...  
Keyword(s):  
Human Milk ◽  
Ebola Virus ◽  
Culture Media ◽  
Plaque Assay ◽  
Marburg Virus ◽  
Donor Human Milk ◽  
Milk Bank ◽  
Viral Plaque ◽  
High Risk Infants ◽  
Milk Banks

Background: Potential donors of human milk are screened for Ebola virus (EBOV) using standard questions, but testing for EBOV and Marburg virus (MARV) is not part of routine serological testing performed by milk banks. Research aim: This study tested the hypothesis that EBOV would be inactivated in donor human milk (DHM) by standard pasteurization techniques (Holder) used in all North American nonprofit milk banks. Methods: Milk samples were obtained from a nonprofit milk bank. They were inoculated with EBOV (Zaire strain) and MARV (Angola strain) and processed by standard Holder pasteurization technique. Plaque assays for EBOV and MARV were performed to detect the presence of virus after pasteurization. Results: Neither EBOV nor MARV was detectable by viral plaque assay in DHM or culture media samples, which were pasteurized by the Holder process. Conclusion: EBOV and MARV are safely inactivated in human milk by standard Holder pasteurization technique. Screening for EBOV or MARV beyond questionnaire and self-deferral is not needed to ensure safety of DHM for high-risk infants.

scholarly journals Bacillus cereus Induces Severe Infections in Preterm Neonates: Implication at the Hospital and Human Milk Bank Level

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 123
Author(s):  
Delphine Cormontagne ◽  
Virginie Rigourd ◽  
Jasmina Vidic ◽  
Francesco Rizzotto ◽  
Emmanuelle Bille ◽  
...  
Keyword(s):  
Human Milk ◽  
Very Low Birth Weight ◽  
Severe Infection ◽  
Preterm Neonates ◽  
Human Breast Milk ◽  
Literature Overview ◽  
Milk Bank ◽  
Severe Infections ◽  
Human Milk Bank ◽  
Milk Banks

Human breast milk (HBM) is a source of essential nutrients for infants and is particularly recommended for preterm neonates when their own mother’s milk is not available. It provides protection against infections and decreases necrotizing enterocolitis and cardiovascular diseases. Nevertheless, HBM spoilage can occur due to contamination by pathogens, and the risk of a shortage of HBM is very often present. B. cereus is the most frequent ubiquitous bacteria responsible for HBM being discarded. It can contaminate HBM at all stages, from its collect point to the storage and delivery. B. cereus can induce severe infection in newborns with very low birth weight, with sometimes fatal outcomes. Although the source of contamination is rarely identified, in some cases, HBM was suspected as a potential source. Even if the risk is low, as infection due to B. cereus in preterm infants should not be overlooked, human milk banks follow strict procedures to avoid contamination, to accurately identify remaining bacteria following pasteurization and to discard non-compliant milk samples. In this review, we present a literature overview of B. cereus infections reported in neonates and the suspected sources of contamination. We highlight the procedures followed by the human milk banks from the collection of the milk to its microbiological characterization in Europe. We also present improved detection and decontamination methods that might help to decrease the risk and to preserve the public’s confidence in this vital biological product for infants whose mothers cannot breastfeed.

scholarly journals Human milk banks in the response to COVID-19: a statement of the regional human milk bank network for Southeast Asia and beyond

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Estrella Olonan-Jusi ◽  
Paul G. Zambrano ◽  
Vu H. Duong ◽  
Nguyen T. T. Anh ◽  
Nant S. S. Aye ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Human Milk ◽  
Newborn Care ◽  
World Health ◽  
National Guidelines ◽  
Donor Human Milk ◽  
Skin Contact ◽  
Milk Bank ◽  
Human Milk Bank ◽  
Milk Banks

Abstract Background The World Health Organization (WHO) recommendations on infant feeding in the context of COVID-19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother’s own milk is not available. Insufficient guidance on the use of donor human milk and the role of human milk banks in the pandemic response COVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding. The use of safe donor human milk accessed through human milk banks is also insufficiently recommended, even in countries with an existing human milk bank, leading to a gap in evidence-based management of COVID-19. This highlights long-standing challenges as well as opportunities in the safe, equitable, and resilient implementation of human milk banks in the region. Conclusions This statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community.

scholarly journals Clinical Results of the Implementation of a Breast Milk Bank in Premature Infants (Under 37 Weeks) at the Hospital Universitario del Valle 2018–2020

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2187
Author(s):  
Javier Torres-Muñoz ◽  
Carlos Alberto Jimenez-Fernandez ◽  
Jennifer Murillo-Alvarado ◽  
Sofia Torres-Figueroa ◽  
Juan Pablo Castro
Keyword(s):  
Breast Milk ◽  
Human Milk ◽  
Premature Infants ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Clinical Results ◽  
Human Breast Milk ◽  
Milk Bank ◽  
Exploratory Data ◽  
Milk Banks

Breast milk is widely recognized as the best source of nutrition for both full term and premature babies. We aimed to identify clinical results of the implementation of a breast milk bank for premature infants under 37 weeks in a level III hospital. 722 neonates under 37 weeks, hospitalized in the Neonatal intensive care unit (ICU), who received human breast milk from the institution’s milk bank 57% (n = 412) vs. mixed or artificial 32% (n = 229), at day 7 of life. An exploratory data analysis was carried out. Measures of central tendency and dispersion were used, strength of association of odds ratio (OR) and its confidence intervals (95% confidence interval (CI)). 88.5% had already received human milk before day 7 of life. Those who received human milk, due to their clinical condition, had 4 times a greater chance of being intubated (OR 4.05; 95% CI 1.80–9.11). Starting before day 7 of life decreases the opportunity to develop necrotizing enterocolitis by 82% (adjusted odds ratio (ORa) 0.18; 95% CI 0.03–0.97), intraventricular hemorrhage by 85% (ORa 0.15; 95% CI 0.06–0.45) and sepsis by 77% (ORa 0.23; 95% CI 0.15–0.33). Receiving human milk reduces the probability of complications related to prematurity, evidencing the importance that breast milk banks play in clinical practice.

Cost Analysis of Operating a Human Milk Bank in China

2020 ◽  
Vol 36 (2) ◽  
pp. 264-272 ◽  
Author(s):  
Cun Daili ◽  
Zhang Kunkun ◽  
Yu Guangjun
Keyword(s):  
Cost Analysis ◽  
Human Milk ◽  
Unit Cost ◽  
Operating Costs ◽  
Children's Hospital ◽  
Donor Human Milk ◽  
Milk Bank ◽  
Children’S Hospital ◽  
Human Milk Bank ◽  
Milk Banks

Background Establishing a human milk bank for the benefit of premature newborns who are unable to receive their mothers’ milk for various reasons is a common initiative. To date, 19 human milk banks have been established in China; however, data associated with human milk banks are lacking, including information on the operational costs, guidelines, and regulatory systems for human milk banks in China. Research Aim Our study aim was to conduct a cost analysis for the human milk bank at Shanghai Children’s Hospital. Methods A management accounting approach, based on the activity-based costing method, was used to develop a cost model for donor human milk. The data were collected retrospectively and included budget plans, financial and expenditure reports, databases, and interviews with the staff and managers at the Shanghai Children’s Hospital Human Milk Bank in 2017. Results In 2017, the total volume of qualified donor human milk was 933.70 L, of which 842.71 L (90%) was frozen and 90.99 L (10%) was freshly donated on site. The total annual cost to provide milk for 212 high-risk infants in 2017 was US$156,923, and the unit cost was US$168/L. Conclusions The operating costs of human milk banks in China are similar to those in other countries internationally, but these costs are so large that they require government and society support for funding and milk donation. Therefore, ongoing breastfeeding support for mothers and measures to reduce the operating costs of human milk banks should be advocated.

scholarly journals “Donor milk banking: Improving the future”. A survey on the operation of the European donor human milk banks

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256435
Author(s):  
Eva Kontopodi ◽  
Sertac Arslanoglu ◽  
Urszula Bernatowicz-Lojko ◽  
Enrico Bertino ◽  
Maria Enrica Bettinelli ◽  
...  
Keyword(s):  
Human Milk ◽  
Web Based ◽  
Donor Human Milk ◽  
Milk Bank ◽  
Wide Variability ◽  
Human Milk Banking ◽  
Milk Banking ◽  
Milk Banks ◽  
Evidence Based Guidelines

Background Provision of donor human milk is handled by established human milk banks that implement all required measures to ensure its safety and quality. Detailed human milk banking guidelines on a European level are currently lacking, while the information available on the actual practices followed by the European human milk banks, remains limited. The aim of this study was to collect detailed data on the actual milk banking practices across Europe with particular emphasis on the practices affecting the safety and quality of donor human milk. Materials and methods A web-based questionnaire was developed by the European Milk Bank Association (EMBA) Survey Group, for distribution to the European human milk banks. The questionnaire included 35 questions covering every step from donor recruitment to provision of donor human milk to each recipient. To assess the variation in practices, all responses were then analyzed for each country individually and for all human milk banks together. Results A total of 123 human milk banks completed the questionnaire, representing 85% of the European countries that have a milk bank. Both inter- and intra-country variation was documented for most milk banking practices. The highest variability was observed in pasteurization practices, storage and milk screening, both pre- and post-pasteurization. Conclusion We show that there is a wide variability in milk banking practices across Europe, including practices that could further improve the efficacy of donor human milk banking. The findings of this study could serve as a tool for a global discussion on the efficacy and development of additional evidence-based guidelines that could further improve those practices.

scholarly journals Role of human milk banks amid COVID 19: perspective from a milk bank in India

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Maheshwar Bhasin ◽  
Sushma Nangia ◽  
Srishti Goel
Keyword(s):  
Human Milk ◽  
Hospital Stay ◽  
Asymptomatic Carrier ◽  
Microbiological Quality ◽  
Developing Nations ◽  
National Guidelines ◽  
Donor Human Milk ◽  
Milk Bank ◽  
Human Milk Banking ◽  
Milk Banks

AbstractThe COVID-19 pandemic has had a significant impact on the operation of donor human milk banks in various countries such as China, Italy and India. It is understandable that this impact on operations of donor human milk might hamper the capability of these milk banks to provide sufficient pasteurized donor milk to neonates who need it. Contrary to developed world, predominant donors in developing nations are mothers of hospitalised neonates who have a relatively long period of hospital stay. This longer maternal hospital stay enhances the feasibility of milk donation by providing mothers with access to breast pumps to express their milk. Any excess milk a mother expresses which is above the needs of their own infant can be voluntarily donated. This physical proximity of milk banks to donors may help continuation of human milk donation in developing nations during the pandemic. Nevertheless, protocols need to be implemented to i) ensure the microbiological quality of the milk collected and ii) consider steps to mitigate potential consequences related to the possibility of the donor being an asymptomatic carrier of COVID-19. We present the procedural modifications implemented at the Comprehensive Lactation Management Centre at Lady Hardinge Medical College in India to promote breastfeeding and human milk donation during the pandemic which comply with International and National guidelines. This commentary provides a perspective from a milk bank in India which might differ from the perspective of the international donor human milk banking societies.

DIAGNÓSTICOS DE ENFERMAGEM DE MULHERES NUTRIZES ATENDIDAS NO BANCO DE LEITE HUMANO

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Nathália Carolina Tomazelli Crespo ◽  
Rosimere Ferreira Santana ◽  
Valdecyr Herdy Alves ◽  
Audrey Vidal Pereira ◽  
Giovanna Rosario Soanno Marchiori ◽  
...  
Keyword(s):  
Human Milk ◽  
Sleep Pattern ◽  
No Donors ◽  
Tissue Integrity ◽  
Disturbed Sleep ◽  
Nursing Diagnosis ◽  
Milk Bank ◽  
Las Mujeres ◽  
Human Milk Bank ◽  
Milk Banks

Objetivo: conhecer o perfil de Diagnósticos de Enfermagem em mulheres nutrizes atendidas no Banco de Leite Humano. Metodologia: estudo descritivo, com 30 mulheres atendidas no Banco de Leite Humano entre doadoras e não doadoras. Os dados foram coletados nos meses de março a maio de 2012. A análise se deu por meio de estatística descritiva. Resultados: os diagnósticos foram descritos para dois grupos: Não doadoras: Disposição para conhecimento melhorado (100,0%), Risco de infecção (80,9%), Integridade Tissular prejudicada (80,9%), Padrão de sono prejudicado (76,1%), Conhecimento deficiente (66,6%), Ansiedade (52,3%); Em Doadoras: Padrão de sono prejudicado (77,7%) e Ansiedade (55,5%). Conclusão: a taxonomia diagnóstica encontra-se de acordo com a população estudada. Validou-se a necessidade do uso dessa tecnologia como um sistema padrão de linguagem.Descritores: Bancos de leite; Diagnóstico de enfermagem; Cuidados de enfermagem; Saúde da mulher; Aleitamento materno.NURSING DIAGNOSIS IDENTIFIED IN WOMEN AT THE HUMAN MILK BANKObjective: to know the profile of Nursing Diagnosis in women hosted in the Human Milk Bank. Methodology: descriptive study, with 30 women attended at the Human Milk Bank between donors and no donors. Data were collected from March to May 2012. The analysis was done through simple descriptive statistics. Results: diagnosis were described for two groups: No donors: Readiness for enhanced knowledge (100.0%), Risk for infection (80.9%), Impaired tissue integrity (80.9%), Disturbed sleep pattern (76.1%), Deficient knowledge (66.6%), Anxiety (52.3%); In Donors: Disturbed sleep pattern (77.7%) and Anxiety (55.5%). Conclusion: the diagnostic taxonomy is in agreement with the studied population. The need to use this technology as a standard language system was validated.Descriptors: Milk banks; Nursing diagnosis; Nursing care; Women’s health; Breastfeeding.ENFERMERÍA DE DIAGNÓSTICO IDENTIFICADOS EN MUJERES ASISTIDA EN BANCO DE LECHE HUMANAObjetivo: conocer el perfil de los diagnósticos de enfermería de las mujeres dio la bienvenida al Banco de Leche Humana. Metodology: estúdio descriptivo, con 30 mujeres atendidas enel Banco de Leche Humana entre los donantes y no donantes. Los datos fueron recolectados entre marzo y mayo de 2012. El análisis se realizó utilizando estadísticas descriptivas simples. Resultados: los diagnósticos han sido descritos por dos grupos: No donantes: Disposición para mejorar los conocimientos (100%), Riesgo de infección (80,9%), Deterioro de la integridade cutánea (80,9%), Trastorno del patrón de sueño (76, 1%), Conocimientos deficientes (66,6%), Ansiedad (52,3%); Em Donantes: Trastorno del patrón de sueño (77,7%) y Ansiedad (55,5%). Conclusión: la taxonomía diagnóstica es función de la población estudiada. Han verificado la necesidad de la utilización de esta tecnología como un sistema estándar de lenguaje.Descriptores: Bancos de leche; Diagnóstico de enfermería; Atención de enfermería; Salud de lamujer; Lactancia materna.

scholarly journals High-Temperature Short-Time and Holder Pasteurization of Donor Milk: Impact on Milk Composition

Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 114
Author(s):  
Diana Escuder-Vieco ◽  
Juan M. Rodríguez ◽  
Irene Espinosa-Martos ◽  
Nieves Corzo ◽  
Antonia Montilla ◽  
...  
Keyword(s):  
High Temperature ◽  
Human Milk ◽  
Milk Composition ◽  
Donor Human Milk ◽  
High Temperature Short Time ◽  
Lactose Concentration ◽  
C 30 ◽  
Milk Banks ◽  
Short Time

Holder pasteurization (HoP; 62.5 °C, 30 min) is commonly used to ensure the microbiological safety of donor human milk (DHM) but diminishes its nutritional properties. A high-temperature short-time (HTST) system was designed as an alternative for human milk banks. The objective of this study was to evaluate the effect of this HTST system on different nutrients and the bile salt stimulated lipase (BSSL) activity of DHM. DHM was processed in the HTST system and by standard HoP. Macronutrients were measured with a mid-infrared analyzer. Lactose, glucose, myo-inositol, vitamins and lipids were assayed using chromatographic techniques. BSSL activity was determined using a kit. The duration of HTST treatment had a greater influence on the nutrient composition of DHM than did the tested temperature. The lactose concentration and the percentage of phospholipids and PUFAs were higher in HTST-treated than in raw DHM, while the fat concentration and the percentage of monoacylglycerides and SFAs were lower. Other nutrients did not change after HTST processing. The retained BSSL activity was higher after short HTST treatment than that following HoP. Overall, HTST treatment resulted in better preservation of the nutritional quality of DHM than HoP because relevant thermosensitive components (phospholipids, PUFAs, and BSSL) were less affected.

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