“It’s more than milk, it’s mental health”: a case of online human milk sharing

Background Milk sharing is not a new concept and occurs today via regulated human milk banks and unregulated online milk sharing groups. Exploring and understanding how, and why, mothers use these peers to peer milk sharing groups, is a vehicle to understanding how breastfeeding mothers can be tangibly supported online, adding to the literature on peer milk sharing, from a recipient’s perspective. This research presents a single case example of an online breastfeeding support group use, through one mother’s experiencing of seeking human donor milk. Method This is a qualitative, exploratory study observing the attitudes, thoughts, and feelings of one mother who is seeking human donor milk through online groups. A single key case was identified, and the participant was asked to document thoughts and feelings as she searched for milk online. A telephone interview was conducted after two months, and the online page activity from the Human Milk for Human Babies Facebook group was captured for the week following the interview. The results were presented in a chronological and linear analytical approach adopting pattern matching. Results ‘Abbi’ is a mother who has Polycystic Ovary Syndrome and subsequent low milk supply and sought donor breastmilk online. Online support groups introduced her to donor milk sharing, which not only supported her breastfeeding but supported her own mental health. Abbi talks of the need to build a trusting relationship with her donor, due to the lack of regulation, and the positive impact it had for her and ‘Lucas’, her baby. Conclusion Considering milk sharing groups simply as tangible online support ignores the complexities around Abbi’s decision to use human donor milk. Peer milk sharing online is an option for mothers, but it is surrounded by stigma amongst other mothers, professionals, and even within pro breastfeeding support groups.

Processing Human Milk to Increase Nutrient Density for Preterm Infants

Background: Human milk is the optimal food for newborns. Choices to feed preterm infants in neonatal intensive care units are mother’s milk, donor milk, or formula. Preterm infants have better tolerance for human milk, but the lower caloric density of donor milk might not meet preterm infant growth needs. Preterm infants have higher protein and energy requirements with a limited stomach capacity. Therefore, there is a need for human milk with increased nutrient density. Research Aim: To concentrate donor milk to have a higher caloric and protein density while avoiding side effects of high osmolality by precipitating lactose at low temperatures. Methods: We investigated the results of volume reduction and lactose removal processes on the lactose, protein, osmolality, and viscosity of human milk. Donor milk was obtained from WakeMed Mothers’ Milk Bank. Homogenization and evaporative condensation were applied to samples ( N = 36) before they were stored frozen overnight, followed by refrigerated centrifugation for lactose removal at 0 °C. Supernatants were separated and compared to the composition of controls. Results: A significant reduction of lactose ( SW = -262, p < .0001) and osmolality ( SW = -211.5 p < .01) was achieved in the concentrated milk without a significant protein loss from centrifugation ( SW = -44.5, p = .49). A 30%–40% volume reduction is within the American Academy of Pediatrics recommended osmolality for infant feeding. Conclusion: Concentrating human milk in a milk bank setting for feeding preterm infants might be a simple and low-cost process to achieve a product with higher nutrient density and no non-human components.

The Effect of Pasteurization on the Antioxidant Properties of Human Milk: A Literature Review

High rates of oxidative stress are common in preterm born infants and have short- and long-term consequences. The antioxidant properties of human milk limits the consequences of excessive oxidative damage. However, as the mother’s own milk it is not always available, donor milk may be provided as the best alternative. Donor milk needs to be pasteurized before use to ensure safety. Although pasteurization is necessary for safety reasons, it may affect the activity and concentration of several biological factors, including antioxidants. This literature review describes the effect of different pasteurization methods on antioxidant properties of human milk and aims to provide evidence to guide donor milk banks in choosing the best pasteurization method from an antioxidant perspective. The current literature suggests that Holder pasteurization reduces the antioxidant properties of human milk. Alternative pasteurization methods seem promising as less reduction is observed in several studies.

51 Donor Milk in the NICU: A Community Pediatrics Perspective

Primary Subject area Community Paediatrics Background Use of pasteurized donor human milk (PDHM) has been recommended as an alternative to formula for preterm or low birth weight infants when mom’s own breast milk (MOM) is unavailable. Studies show that compared to PDHM, formula-fed neonates had better growth rates but were at increased risk of necrotizing enterocolitis (NEC) and feeding intolerance. Notably, most of these studies were conducted in tertiary-level NICUs. The Canadian Paediatric Society recommends PDHM as an alternative to formula for neonates admitted to NICUs. However, at time of study, PDHM was not offered in many community NICUs. Objectives The aim of this project is to determine whether the introduction of donor milk in the Level 2B NICU at Grand River Hospital has made a difference in rates of suspected NEC, feeding intolerance, growth, and length of hospital stay. Design/Methods We conducted a retrospective pre-post study comparing medical records of neonates in the NICU who met the criteria to receive PDHM 2 years after the introduction of PDHM at our centre (October 2017 to September 2019) to neonates who met the same criteria but were admitted prior to introduction of PDHM (October 2015 to September 2017) and thus received formula. Neonates who received privately purchased donor milk were excluded from our analysis. Results Gestational age and birth weight was similar for the PDHM (n=127) and control (n=120) groups. Compared to the PDHM group, formula-fed neonates were more likely to be transferred to a tertiary care NICU for concerns of suspected NEC (8.9% vs. 3.1%, p=0.017). When comparing any feeding intolerance, there was no significant difference between the two groups (p=0.23). Neonates receiving PDHM had higher average daily weight gain (33.9 vs. 28.9, p &lt; 0 .001), but were more likely to receive additional calorie supplementation. There were no differences in length of hospital stay. Conclusion The data from our community NICU support the current literature that infants who receive formula are at increased risk for transfer for suspected NEC compared to those who receive PDHM. However, in our centre, there appears to be no difference in rates of feeding intolerance, and neonates fed fortified PDHM appeared to have better growth rates. Results from this study can be used to guide the allocation of health care resources, and can be applied to other community centres. Future studies can look to replicating these results on a larger scale and analyze the cost-effectiveness of PDHM use in community centers.

Turkish Women’s Beliefs Concerning Human Milk Banking

Background: A donor milk bank provides an alternative source of human milk for mothers who cannot breastfeed or provide their own milk. Although wet-nursing is a common practice, there is currently no donor milk bank in Turkey. Research Aims: The aims of our study were (1) to determine the knowledge and opinions of Turkish women in regard to donor milk banking; and (2) to raise awareness of donor milk banking. Methods: This was a prospective cross-sectional descriptive study, in which the data were collected with an online survey consisting of 22 questions. The link to the online survey was distributed through the social media accounts of the researchers, with a statement inviting women aged 18–64, who were literate and actively using social media, to participate in the survey. There were 648 female participants. Results: Of those who responded to the questionnaire, 54.1% had not previously given birth, and 54.2% had heard about donor milk banks before. The implementation of donor milk banks in Turkey was desired by 56.4% of the participants, and 50.8% of the participants considered donating their milk. It was determined that the reasons why the women did not want to benefit from donor milk banks were the risk of disease transmission to the baby and the possibility of their child marrying his or her milk sibling in the future. Conclusion: It appears that Turkish women lack information about donor milk banking. We recommend public awareness activities to be organized concerning donor milk banking.

Epitope-Specific Response of Human Milk Immunoglobulins in COVID-19 Recovered Women

The breastfeeding of infants by mothers who are infected with SARS-CoV-2 has become a dramatic healthcare problem. The WHO recommends that infected women should not abandon breastfeeding; however, there is still the risk of contact transmission. Convalescent donor milk may provide a defense against the aforementioned issue and can eliminate the consequences of artificial feeding. Therefore, it is vital to characterize the epitope-specific immunological landscape of human milk from women who recovered from COVID-19. We carried out a comprehensive ELISA-based analysis of blood serum and human milk from maternity patients who had recovered from COVID-19 at different trimesters of pregnancy. It was found that patients predominantly contained SARS-CoV-2 N-protein-specific immunoglobulins and had manifested the antibodies for all the antigens tested in a protein-specific and time-dependent manner. Women who recovered from COVID-19 at trimester I–II showed a noticeable decrease in the number of milk samples with sIgA specific to the N-protein, linear NTD, and RBD-SD1 epitopes, and showed an increase in samples with RBD conformation-dependent sIgA. S-antigens were found to solely induce a sIgA1 response, whereas N-protein sIgA1 and sIgA2 subclasses were involved in 100% and 33% of cases. Overall, the antibody immunological landscape of convalescent donor milk suggests that it may be a potential defense agent against COVID-19 for infants, conferring them with a passive immunity.

Factors Associated with the Use of Pasteurized Donor Milk for Healthy Newborns: Experience from the First Human Milk Bank in Vietnam

Background: Pasteurized donor milk (PDM) is typically prescribed to preterm or low birthweight newborns when their mother’s own milk is unavailable. In surplus, PDM is prescribed to meet the nutritional needs of healthy newborns in the first few days of life. However, its overuse can undermine efforts to promote and support breastfeeding, waste resources, and reduce the availability of PDM for at-risk newborns. We conducted this study to examine factors associated with the prescription and prolonged use (>48 h) of privately purchased PDM to healthy newborns. Methods: Prospective observational study of 2440 mothers of healthy, term, and normal birthweight newborns born at Da Nang Hospital for Women and Children between April and August 2019. In addition to the descriptive analysis, we performed multiple logistic regressions to examine factors associated with the prescription of PDM (n = 2440) and prolonged PDM use among those who used PDM (n = 566). Results: Twenty-three percent (566/2440) of healthy, term, and birthweight ≥2500 g newborns received PDM and were included in the study. The prevalence of PDM use was higher for cesarean births (OR: 2.05; 95% CI: 1.66, 2.55) and among male newborns (OR: 1.33; 95% CI: 1.09, 1.62), but lower for farmers or workers (vs. other jobs; OR: 0.71; 95% CI: 0.54, 0.93), family income <10 million VND (vs. ≥10 million VND; OR: 0.67; 95% CI: 0.55, 0.82), and duration of skin-to-skin ≥90 min (vs. <90 min; OR: 0.54; 95% CI: 0.39, 0.76). Prolonged PDM use (12.4% of 566 newborns who used PDM) was associated with the mother having a higher socioeconomic status job (professional, small trader or homemaker; OR: 4.00; 95% CI: 1.39, 12.5), being a first-time mother (OR: 3.39; 95% CI: 1.92, 6.01) or having a cesarean birth (OR: 2.09; 95% CI: 1.02, 4.28). Conclusions: The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.