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Transversal study conducted in a Human Milk Bank to evaluate the factors associated with the use of artificial nipples (pacifier and/or nursing bottle) among Brazilian infants. Analyses were performed using the χ2 test and logistic regression analysis. A total of 6017 nursing mothers were evaluated and the use of artificial nipples was reported by 31.3%. The chance of using artificial nipples was higher among infants whose mothers attended antenatal care in private hospitals [odds ratio (OR): 1.61, 95% confidence interval (CI) 1.21–2.14], born in maternities without the Baby-Friendly Hospital Initiative (BFHI) (OR: 18.38, 95% CI 13.50–25.04) and those with adequate birth weight (OR: 2.83, 95% CI 1.99–4.03). A lower chance of using artificial nipples was observed among infants whose mothers had previous breastfeeding experience (OR: 0.76, 95% CI 0.61–0.95), received guidance on breastfeeding during antenatal care (OR: 0.80, 95% CI 0.65–0.98), practiced exclusive breastfeeding (OR: 0.36, 95% CI 0.28–0.45), breastfeeding on demand (OR: 0.66, 95% CI 0.52–0.85) and residents of inland cities/towns (OR: 0.38, 95% CI 0.20–0.72). The findings highlight the importance of breastfeeding guidance during antenatal care and the role of BFHI in clarifying risks associated with artificial nipple use.

Background: Donor human milk plays a vital part in the care of sick neonates. There is paucity of literature on the profile of human milk donors of low- and middle-income countries (LMICs). Materia...

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.

Objectives: to identify the main quality management interventions used by professionals working at Human Milk Banks. Methods: a scope review conducted at PubMed, VHL, Scopus, SciELO, CAPES thesis and Google Scholar databases. Primary studies were included that address quality improvement strategies to improve Milk Bank processes in Portuguese, English and Spanish. Results: search totaled 192 scientific studies, 17 of which met the objective of the study and inclusion criteria. The main quality management interventions used in the Human Milk Bank addressed tools for continuous improvement. Six were aimed at improving processes, one to prevent errors and failures and two to achieve continuous monitoring. Final Considerations: the tools used by professionals working in Human Milk Banks have demonstrated effectiveness in managing the quality of services.

Human breast milk is a high value biological substance that grants numerous benefits both to mother and child. Many aspects can produce changes in the milk composition; among them, the pre-conception body mass index (Pre-conception BMI) which is included as a factor that can influence the fat levels and therefore, the milk's energy density. To identify if there is a relation between the breast milk energy density from a human milk bank and Preconception BMI. It is a retrospective study that used information from donations registered in the human milk database at Hospital de Kennedy during 2016. The dependent variable is the energy density from 3 kinds of milk: colostrum, mature and transition milk. As independent variable, Preconception BMI was taken. The R free program version 3.3.0 was used for statistical analysis. The energy density average found for the 3 kinds of milk were: 20.59 + /- 2.3 kcal/oz, 20.51 + /- 2.17 kcal/oz y 19.21 + /- 2.53 for colostrum, transition milk and mature milk respectively. The Preconception BMI average from the donors was 23.56 Kg/m2 for colostrum, 23.9 Kg/m2 for transition milk and 23.1 Kg/m2 for mature milk. No relation between Preconception BMI and energy density of colostrum was found. However, for transition milk and Preconception BMI a directly proportional relation was found (p < 0.01), and for mature milk and Preconception BMI an inversely proportional relation was determined (p = 0.0387). There are internal and external factors than can affect the breast milk lipid content, such as movements of reserves through the organism to protect the milk production, hormonal action, dietary intake, physical activity and socio-economic and cultural aspects; that is why it is not possible to analyze the preconception BMI as a unique predictor of breast milk energy density in an isolated manner. Preconception BMI is related to human breast transition and mature milk energy density in donations registered in 2016 at Kennedy Hospital.

Human Milk banks have been established in many parts of the world. The main purpose of these banks is to save the babies’ lives and to ensure that the newborn babies’ rights to breast milk are fulfilled. Especially for the infants whose Mothers could not feed them due to illness, lack of milk or lack of time. The problem is that milk bank practices in the Western countries contradict with the Islamic law whereby it may result in the possibility of overlapping of the progeny (nasab) and selling the organ of human, etc. The Muslim countries have been not participating in these milk sharing activities because of these religious issues. However, due to a critical need of breast milk in hospitals, this article addresses these issues and the different opinions of Islamic scholars and suggests ways to formulate a proper model of milk bank that is compatible with the Islamic law and to avoid further problems of nasab. This study has two main objectives: firstly, to introduce Milk Bank, causes of its’ existence, method of collection and storage the milk, the benefits of breastfeeding and the unpleasant effects of Milk Banks. Secondly, to review some authoritative legal scholars’ opinions on the issue of milk bank and to recommend a proposal on how to develop a milk bank in accordance with the Islamic law. The study is expected to be able to recognize the issues of Milk Bank, to make the people become aware of its side effects and religious problem.

Objective: To evaluate the quality of the human milk expressed at home and at a human milk bank. Methods: This a retrospective, analytical, and observational study, performed by assessing titratable acidity records and the microbiological culture of 100 human milk samples expressed at home and at a human milk bank, in 2014. For the statistical analysis, generalized estimating equations (GEE) and the chi-squared test were used. Results: When comparing the two sample groups, no significant difference was found, with 98% and 94% of the samples being approved among those collected at the milk bank and at home, respectively. No main interaction effect between local and titratable acidity records (p = 0.285) was observed, and there was no statistically significant difference between the expected and observed values for the association between the collection place and the microbiological culture results (p = 0.307). Conclusions: The quality of human milk expressed at home and at the milk bank are in agreement with the recommended standards, confirming that the expression of human milk at home is as safe as expression at the human milk bank, provided that the established hygiene, conservation, storage, and transport standards are followed. Resumo: Objetivo: Avaliar a qualidade do leite humano ordenhado em domicílio e no Banco de Leite Humano. Métodos: Estudo retrospectivo, realizado por meio da avaliação dos registros da acidez titulável e dos resultados de cultura microbiológica de 100 amostras de leite humano ordenhado em domicílio e em um Banco de Leite Humano, no ano de 2014. Para análises estatísticas foram utilizadas as Equações de Estimação Generalizadas (Generalized Estimating Equations - GEE) e o teste Qui-quadrado. Resultados: Na comparação dos dois grupos de amostras, não foi detectada diferença significativa, sendo que 98% e 94% das amostras foram aprovadas entre as coletadas no Banco de Leite e em domicílio, respectivamente. Não foi observado efeito principal de interação entre local e grau de acidez titulável (p = 0,285) e não se constatou diferença estatisticamente significante entre os valores observados e esperados para associação entre local de coleta e o resultado da cultura microbiológica (p = 0,307). Conclusões: A qualidade do leite humano ordenhado em domicílio e no Banco de Leite Humano estão de acordo com o padrão preconizado, comprovando que a ordenha de leite humano em domicílio é tão segura quanto a ordenha no Banco de Leite Humano, desde que sejam seguidas as normas de higiene, conservação, armazenamento e transporte estabelecidas. Keywords: Human milk, Breast milk expression, Milk banks, Housing, Quality control, Palavras-chave: Leite humano, Extração de leite, Bancos de Leite, Habitação, Controle de qualidade

PiAstra is a simulated flash-heat (FH) pasteurization temperature monitoring system designed using Raspberry Pi technology for the pasteurization of human milk. This study analyzed the effect of the PiAstra FH method on human milk immune components (immunoglobulin A [IgA] and lactoferrin activity).Donor milk samples (N = 45) were obtained from a human milk bank, and pasteurized. Concentrations of IgA and lactoferrin activity were compared to their unpasteurized controls using the Student's t test.The PiAstra FH method retained 34.2% of IgA (p 0.0001) and 40.4% of lactoferrin activity (p 0.0001) when compared to unpasteurized controls. The retention of IgA by the PiAstra is similar to previous FH studies, while retention of lactoferrin activity was higher than previous FH studies.The high-technology, low-cost PiAstra system, which is able to retain vital immune components of human milk, provides safe donor milk for low-resourced settings. This enables the use of pasteurized donor milk when human milk is not available, potentially saving vulnerable infant lives.

Donor human milk is considered the next best nutrition following mother's own milk to prevent neonatal infection and necrotizing enterocolitis in preterm infants who are admitted at neonatal intensive care unit. However, donor milk biofunctionalities after preparative processes have rarely been documented.To evaluate biofunctionalities preserved in donor milk after preparative processes by cell-based assays.Ten pools of donor milk were produced from 40 independent specimens. After preparative processes, including bacterial elimination methods (holder pasteurization and cold-sterilization microfiltration) and storage conditions (-20°C freezing storage and lyophilization) with varied duration of storage (0, 3, and 6, months), donor milk biofunctionalities were examined by fetal intestinal cell growth and antimicrobial assays.At baseline, raw donor milk exhibited 193.1% ± 12.3% of fetal intestinal cell growth and 42.4% ± 11.8% of antimicrobial activities against Escherichia coli. After bacteria eliminating processes, growth promoting activity was better preserved in pasteurized donor milk than microfiltrated donor milk (169.5% ± 14.3% versus 146.0% ± 11.8%, respectively; p 0.005), whereas antimicrobial activity showed no difference between groups (38.3% ± 14.1% versus 53.7% ± 17.3%, respectively; p = 0.499). The pasteurized donor milk was further examined for the effects of storage conditions at 3 and 6 months. Freezing storage, but not lyophilization, could preserve higher growth-promoting activity during 6 months of storage (163.0% ± 9.4% versus 72.8% ± 6.2%, respectively; p 0.005). Nonetheless, antimicrobial activity was lost at 6 months, regardless of the storage methods.This study revealed that fetal intestinal cell growth and antimicrobial assays could be applied to measure donor milk biofunctionalities and support the utilization of donor milk within 3 months after preparative processes.

Nutritional status of donors of human milk (HM) to a human milk bank was investigated as a factor capable of modulating lipid concentrations of this food. Colostrum and transitional milk from 55 women with different body mass indexes (eutrophic, overweight and obese) were collected and separated into pools to evaluate the fatty acid composition and triacylglycerols lipid profile. Gas chromatograph with flame ionization detector (GC-FID) and electrospray ionization mass spectrometer (ESI-MS) were applied in these pools. Transitional milk pool from overweight donors showed the highest percentages of caprylic acid, which were 2.39 %. The trans 10, cis 12 isomer stood out in the colostrum pool of donors with overweight with values of 0.31 %. Despite the α-linolenic precursor of the omega-3 family showing higher concentrations in the colostrum pool of obese donors, long-chain polyunsaturated fatty acids (LC-PUFAs) such as eicosapentaenoic (Epa) and docosahexaenoic (Dha) showed lower values in the obese donors colostrum and transitional pools, determined by GC-FID analysis. The concentrations of Epa and Dha in the colostrum pool of eutrophic donors were 0.42 % and 0.34 %, respectively, while in the colostrum pool of obese donors the values found for Epa (0.17 %) and Dha (0.26 %) were significantly lower. In the transitional milk pool of eutrophic donors, Epa concentrations were 0.31 % and Dha 0.32 %; already in the obese donors pool, Epa and Dha presented values of 0.08 % and 0.09 %, respectively, showing a significant difference (p

The objective of this study is to study the impact of a Human Milk Bank (HMB) on neonatal mortality, incidence of necrotizing enterocolitis (NEC) and rate of exclusive breastfeeding.This pre-post intervention study was conducted in a tertiary care teaching institute in south India. Data regarding neonatal mortality, incidence of NEC, and exclusive breastfeeding rates were collected for a period of 6 months before and after establishing a modern HMB and compared.The number of deliveries, live births, and incidence of preterm and VLBW neonates during pre- and post-HMB periods were comparable. Neonatal mortality was 11.32/1000 live births pre-HMB compared with 10.77/1000 live births post HMB. The incidence of NEC was 1.26% of live births pre-HMB compared with 1.07% post-HMB. Exclusive breastfeeding rate pre-HMB was 34% compared with 74% post HMB (p .001).There is a decreasing trend in neonatal mortality and incidence of NEC after establishing a HMB. Human milk banking significantly improved exclusive breastfeeding rate in the population studied.

Objective: To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Methods: Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted prevalence ratios (APR) by Poisson regression with robust variance. The final model included the variables associated with breast milk donation (p ≤ 0.05). Results: 7.3% of the mothers had donated breast milk. Having been encouraged to donate breast milk by healthcare professionals, relatives, or friends (APR = 7.06), receiving information on breast milk expression by the primary health care unit (APR = 3.65), and receiving help from the unit professionals to breastfeed (APR = 2.24) were associated with a higher prevalence of donation. Admission of the newborn to the neonatal unit was associated with a lower prevalence of donation (APR = 0.09). Conclusions: Encouragement to breast milk donation, and information and help provided by primary health care unit professionals to breastfeeding were shown to be important for the practice of human milk donation. Resumo: Objetivo: Estimar a prevalência e analisar os fatores associados à doação de leite materno em unidades básicas de saúde com vistas a aumentar os estoques dos bancos de leite humano. Métodos: Estudo transversal conduzido em 2013 na cidade do Rio de Janeiro, Brasil, mediante entrevista a uma amostra representativa de 695 mães de crianças menores de 1 ano assistidas nas 9 unidades básicas de saúde com posto de recebimento de leite humano ordenhado. Razões de prevalência ajustadas (RPa) foram obtidas por modelo de regressão de Poisson com variância robusta, segundo modelo hierarquizado. O modelo final foi composto pelas variáveis que se associaram à doação de leite materno por profissionais de saúde (p ≤ 0,05). Resultados: Doaram leite materno 7,3% das mães. Ter sido incentivada a doar leite materno por profissionais de saúde, parentes ou amigos (RPa = 7,06), ter recebido orientação da unidade básica sobre ordenha das mamas (RPa = 3,65) e ter recebido ajuda da unidade básica para amamentar (RPa = 2,24) se associaram a uma maior prevalência de doação, enquanto a internação prévia do bebê em unidade neonatal se associou a uma menor prevalência (RPa = 0,09). Conclusões: Ficou evidente a importância do incentivo à doação, das orientações e da ajuda da unidade básica para amamentar para a prática de doação de leite materno. Keywords: Human milk, Milk banks, Cross-sectional studies, Primary health care, Donation, Epidemiology, Palavras-chave: Leite humano, Bancos de leite, Estudos transversais, Atenção primária à saúde, Doação, Epidemiologia

Growing evidence supporting the health benefits of human milk, particularly in the preterm population, has led to rising demand for donor human milk in NICUs and pediatric hospitals. There are no previous reports describing the use of unpasteurized shared human milk (USHM) in the hospital setting, but the use of USHM solicited from community donors through social networks appears to be common. Many pediatric hospitals permit inpatients to receive breast milk that has been screened and pasteurized by a human milk banking organization and will provide pasteurized donor human milk (PDHM) only to infants who are preterm or have specific medical conditions. These policies are designed to minimize potential adverse effects from improperly handled or screened donor milk and to target patients who would experience the greatest benefit in health outcomes with donor milk use. We explore the ethical and health implications of 2 cases of medically complex infants who did not meet criteria in our tertiary care hospital for the use of PDHM from a regulated human milk bank and were incidentally found to be using USHM. These cases raise questions about how best to balance the ethical principles of beneficence, nonmaleficence, justice, and patient autonomy in the provision of PDHM, a limited resource. Health care staff should ask about USHM use to provide adequate counseling about the risks and benefits of various feeding options in the context of an infant’s medical condition.

Objectives: to identify the reasons for human milk donation according to different per capita income in donors who were registered in the human milk bank and center to promote breastfeeding at Instituto de Medicina Integral Professor Fernando Figueira (HMB/CIAMA/IMIP). Methods: this is a cross-sectional study. Data collection was carried out at the HMB/CIAMA/IMIP from March to May 2015. The sample was consisted of 155 donors. The data were obtained by applying a form elaborated by the researchers. For the data analysis the SPSS 13.0 software for Windows and Excel 2010 were used. Results: the reasons most mentioned by the donors with a per capita income of < 0.5 minimum wages were, in descending order: excess of milk /avoid wasting, solidarity, altruism and return to work. Donors with a per capita income of ≥ 0.5 minimum wages were, excess of milk /avoid wasting and return to work were the main reasons for donation, followed by solidarity and altruism. Conclusions: the reasons for human milk donation varied according to the per capita income. This knowledge will contribute with the necessary information for planning/improved interventions to capture new donors locally and nation wide.

Resumo Este artigo objetivou avaliar práticas educativas segundo os “Dez Passos para o Sucesso do Aleitamento Materno” em Banco de Leite Humano. Estudo retrospectivo com informações sociodemográficas e gestacionais maternas e referentes ao bebê, obtidas de protocolo de atendimento de nutrizes (2009-2012). Tais dados foram associados aos passos relacionados a práticas educativas dentre os “Dez Passos”. Realizou-se análise descritiva, teste qui-quadrado e regressão de Poisson. Foram avaliadas 12.283 mães, com mediana de 29 (12-54) anos de idade. As orientações recebidas sobre amamentação no pré-natal (passo 3) prevaleceram entre mães de 30-39 anos e o contato pele/pele (passo 4) entre as orientadas. O treinamento sobre amamentação (passo 5) predominou entre aquelas que amamentaram exclusivamente. Notou-se maior prevalência de amamentação exclusiva (passo 6) e sob livre demanda (passo 8) e uso de bicos artificiais (passo 9) entre os lactentes de mães orientadas. Os achados apontam importante papel do profissional da saúde no treinamento mãe/filho sobre aleitamento materno e incentivo ao contato pele/pele, amamentação exclusiva e sob livre demanda. As orientações ofertadas necessitam aprimoramento a fim de reduzir o uso de bicos artificiais e potencializar a amamentação exclusiva. Abstract This article sought to evaluate educational practices in line with the “Ten Steps to Successful Breastfeeding” in a Human Milk Bank. It involved a retrospective study using sociodemographic data about the pregnancy and the baby, obtained from a nursing mothers care protocol (2009-2012). These data were associated to steps related to educational practices from the “Ten Steps.” Descriptive analysis, chi-square test and Poisson regression were performed. 12,283 mothers, with a median of 29 (12-54) years old, were evaluated. The guidelines about breastfeeding received during prenatal care (step 3) prevailed among mothers aged 30-39 years and the skin to skin contact (step 4) prevailed among oriented mothers. Breastfeeding training (step 5) predominated among those who breastfed exclusively. Higher prevalence of exclusive breastfeeding (step 6), breastfeeding on demand (step 8) and use of artificial nipples (step 9) were noted among infants whose mothers were oriented. These findings indicate the important role of health professionals on mother/child training about breastfeeding, on encouragement of the skin/skin contact, exclusive breastfeeding and breastfeeding on demand. The guidelines indicated the need to improve in order to reduce the use of artificial nipples and enhance exclusive breastfeeding.

The aim of human milk banks is to deliver safe and high quality donor human milk. Treatment of human milk has to destroy most microorganisms while preserving immunological and nutrient components, which is obtained when using low time low temperature pasteurization. However it destroys bile-simulated lipase, reduces lactoferrin, lysozyme, immunoglobulins, and bactericidal capacity of human milk. New methods are under investigation such as high temperature short time pasteurization, high pressure processing, or ultraviolet irradiation. They have been tested in experimental conditions and there are promising results, but they have to be tested in real conditions in human milk bank.

Introduction The bacterial content of donated human milk is either endogenous or introduced via contamination. Defining milk bank bacterial content will allow researchers to devise appropriate tests for significant and commonly encountered organisms. Objective A retrospective audit was conducted on data recorded from the Perron Rotary Express Milk Bank, King Edward Memorial Hospital, Subiaco, Western Australia. This aimed to describe the incidence of bacterial species detected in donated human milk and to identify potentially pathogenic bacteria. Material and methods The data comprised of 2890 batches donated by 448 women between 2007 and 2011. Results Coagulase negative Staphylococcus (CoNS) represented the highest prevalence of bacteria in donated milk, isolated from 85.5% of batches (range: 20 to 650,000CFU/mL) followed by Acinetobacter species in 8.1% of batches (range: 100 to 180,000CFU/mL). Staphylococcus aureus was the most prevalent potentially pathogenic bacteria in 5% of batches (range: 40 to 100,000CFU/mL). Conclusion Further investigation is warranted to better define the risks posed by the presence of toxin-producing S. aureus in raw and pasteurized human milk which may allow minimization of risk to the preterm infants.

Advances have been made recently in neonatal nutrition in Japan, including a new donor human milk bank. However, little is known about the knowledge level of neonatal nutrition, donor human milk banks, and human milk fortifiers among Neonatal ICU (NICU) nurses. An anonymous survey was administered during an educational program to assess general knowledge. The overall response rate was 87.6% (219/250). About 60% reported working in the NICU for 1–5 years, and 42% reported that their NICU admitted more than 30 very low birth weight infants per year. Two-thirds (66.4%) acknowledged the existence of the new donor human milk bank. About half (46%) of NICU nurses incorrectly believed that the human milk fortifier available in Japan was derived from human milk rather than cow's milk. It would be beneficial to provide more education to NICU nurses on neonatal nutrition, donor human milk, milk banks, and the use of human milk fortifiers, both cow's milk-based and human milk-based.

O leite materno é considerado o alimento mais completo para o bebê, bem como a principal fonte disponível de nutrientes pelas peculiaridades de sua composição nutricional. É, sem dúvida, o alimento mais adequado, assegurando ao recém-nascido uma ótima adaptação ao seu novo ambiente. Objetivo: identificar e quantificar as causas das perdas de leite humano, com base nos processos executados no BLH-JF, a fim de propor estratégias corretivas. Métodos: estudo observacional transversal, a coleta dos dados consistiu em identificar e quantificar as perdas relacionadas às variáveis referentes ao processamento do leite humano, provenientes do Banco de Dados do Sistema Único de Saúde. Resultados: dos 3140 frascos analisados, apresentou uma perda total de 32,4% dos frascos recebidos no BLH. Com relação ao volume foi identificado uma perda de 214,99 litros de leite, ou seja, 33,9% de perdas de um total recebido de 633,49 litros. Quanto à escolaridade, 88,4% das doadoras têm ensino médio em conjunto com as que têm curso superior; idade gestacional foi maior entre 30 a 42 semanas com 51,7%. Procedência, doadoras do BLH com 61,1% e Postos de Coleta 38,9%. Associação de dados referente a tipos de perdas e escolaridade foi de 42,3% para ensino fundamental, sujidade com 20,8% seguidos por acidez com 18,3% de perdas; com relação a idade, a frequência foi maior na faixa etária até 19 anos com 53,9% de perdas, sujidade com 27,2% seguidos por acidez com 25,3%. Conclusão: as perdas ocorrem e podem ser minimizadas. Destaca-se a importância de que os profissionais do Banco de Leite Humano necessitam de capacitações contínuas e avaliar a forma de como essas orientações são repassadas para as mães doadoras. Sugere-se um maior incentivo por parte dos gestores em formar equipes multiprofissionais compromissadas com saúde materno-infantil Breast milk is considered the most complete food for the baby, as well as the main available source of nutrients due to the peculiarities of its nutritional composition. It is undoubtedly the most suitable food, ensuring the newborn optimally adapts to its new environment. Objective: To identify and quantify the causes of human milk losses, based on the processes performed in the BLH-JF, in order to propose corrective strategies. Methods: cross-sectional observational study, data collection consisted in identifying and quantifying the losses related to the variables related to the processing of human milk from the Unified Health System Database. Results: of the 3140 bottles analyzed, there was a total loss of 32.4% of the vials received in the BLH. Regarding volume, a loss of 214.99 liters of milk was identified, ie 33.9% of losses from a total received of 633,49 liters. As for education, 88.4% of donors have high school together with those with higher education; gestational age was higher between 30 to 42 weeks with 51.7%. Provenance, BLH donors with 61.1% and Collection Stations 38.9%. Data association regarding types of losses and schooling was 42.3% for elementary school, dirt with 20.8% followed by acidity with 18.3% losses; Regarding age, the frequency was higher in the age group up to 19 years with 53.9% losses, dirt with 27.2% followed by acidity with 25.3%. Conclusion: losses occur, and can be minimized. The importance is highlighted that the Human Milk Bank professionals need continuous training, and to assess how these guidelines are passed on to donor mothers. A greater incentive is suggested part of managers to form multiprofessional teams committed to maternal and child health.

Objectives: The aim of the study was to present the variability of patients who received donor human milk (DHM) during Neonatal Intensive Care Unit (NICU) hospitalization, including time of its usage and volume of portions. Material and methods: A retrospective analysis of data was conducted for all infants admitted to the NICU at the University Hospital during the first year of the Human Milk Bank operation. One-way analysis of variance in the intergroup scheme, Kruskal-Wallis variance analysis with the Jonckheere-Tepstra test, correlation analysis using Pearson’s r and Spearmann’s rho, frequency analysis using the Fisher’s exact test were used to conduct analyses. Results: 133 newborns received DHM. 3 groups of neonates were identified: 37 0/7 weeks of gestational age (GA). Time of DHM supplementation was similar in all groups and does not differ depending on the GA but preterm infants received the smallest total volume of DHM. However, infants > 37 weeks of GA had almost a threefold greater chance of abandoning breastfeeding than the others (odds ratio (OR) = 2.89, 95% CI: 0.69–12.20). There was a statistically significant, weak negative correlation between period of total parenteral nutrition and the volume of milk from the bank: rho = –0.194; p = 0.026. Conclusions: The DHM supply did not have a negative impact on lactation and breastfeeding. Stimulation of lactation was necessary for 5–7 days. The time of DHM supply was the same regardless of GA. The majority of infants were breastfed or received only MOM on the day of discharge from the hospital.

The bacteriological profiles of human milk samples collected from individual donors under supervised conditions of collection were compared to pooled human milk samples obtained from a commercial human milk bank. Total aerobic counts and total coliform counts of individual donor samples were lower than those of pooled, banked human milk. All of the 200 isolates from ten individual samples were staphylococci with Staphylococcus epidermidis predominating (82%). Only 1% of the isolates was identified as Staphylococcus aureus . Forty-two percent of the 100 isolates from five pooled samples were staphylococci and all of these staphylococci were coagulase-negative. Three percent of the isolates from the pooled samples were Streptococcus faecalis . The remainder (55%) were gram-negative organisms. S. epidermidis was the microorganism that was isolated most frequently from either individual (9 of 10) or pooled (3 of 5) samples.

Introduction: Mother's own milk has long been accepted as the best source of nutrition for the newborn. In those cases where mother's milk is not available, the best choice is the human milk provided by selected donors. Human milk banks are the most institutionalized method of milk sharing and play a vital role for neonates that cannot be breastfed. This study aims at systematically reviewing factors influencing donation to human milk banks. Materials and Methods: A systematic review of the literature was performed on authentic electronic resources, including PubMed, Scopus, Embase, ScienceDirect, and Web of Science with no time limitation. To increase the sensitivity and to find additional studies for systematic review, the reference list of the published studies was examined as well. Data extraction and quality appraisal were carried out by two independent reviewers. The study was qualitatively summarized to generate descriptive and explanatory themes that emerged from the literature. Results: From a total of 1,157 articles, 31 met the inclusion criteria in which 64 factors are extracted. From these, 26 factors act as barriers and 38 factors act as facilitators of milk donation. Having excess milk, altruism, and helping other babies are found to be the most important facilitators of milk donation, while the most important barriers are religious and cultural concerns. Conclusion: Developing practical strategies to attract milk donors are crucial for successfully establishing human milk banks. These include providing reliable information regarding the milk bank goals and functions and developing breastfeeding polices with regard to differences in countries' contexts and trying to resolve any uncertainties regarding milk donation, especially those arising for religious concerns.

BACKGROUND: When mother's milk is insufficient, pasteurized human donor milk (DM) is the recommended supplement for hospitalized very-low-birth-weight infants. The current method of pasteurization (Holder, 62.5°C, 30 min) negatively affects heat-sensitive nutrients and bioactive proteins. OBJECTIVES: Objectives of this study were to compare changes in DM composition after thermal pasteurization (Holder and flash-heating) and nonthermal methods [UV-C irradiation and high hydrostatic pressure (HHP)]. We hypothesized that nonthermal techniques would result in fewer changes to composition. METHODS: Holder, flash-heating (brought to boil), UV-C irradiation (250 nm, 25 min), and HHP (500 MPa, 8 min) were studied. Pools of milk from 17 women known to contain bacteria at >5 × 10(7) colony forming units (CFU)/L were collected from the Rogers Hixon Ontario Human Milk Bank and underwent each pasteurization technique. Macronutrients, heat-sensitive micronutrients (vitamin C, folate), and bioactive components [bile-salt-stimulated lipase (BSSL), lysozyme, lactoferrin] were measured in raw and pools of pasteurized milk. Milk was cultured to determine how well each technique produced a culture negative result (detection limit

Background: Preterm infants are especially vulnerable to gut microbiota disruption and dysbiosis since their early gut microbiota is less abundant and diverse. Several factors may influence infants’ gut microbiota, such as the mother’s diet, mode of delivery, antibiotic exposure, and type of feeding. Objectives: This study aims to examine the factors associated with very-preterm neonate’s intestinal microbiota, namely: (1) type of infant-feeding (breast milk, donor human milk with or without bovine protein-based fortifier, and preterm formula); (2) maternal diet; and (3) mode of delivery. Methods: This is an observational study conducted in a cohort of very preterm infants hospitalized in the neonatal intensive care unit of Maternidade Dr. Alfredo da Costa. After delivery, the mothers are asked to collect their own fecal samples and are invited to complete a semiquantitative food frequency questionnaire. The maternal diet will be classified in accordance to the Mediterranean Diet adherence score. Stool samples have been collected from very premature infants every 7 days for 21 days. DNA has been extracted from the fecal samples, and different bacterial genus and species will be quantified by real-time polymerase chain reaction. Results and Conclusions: It is hypothesized that significant differences in the microbiota composition and clinical outcomes of very preterm infants will be observed depending on the type of infant feeding. In addition, this study will clarify how pasteurized donor’s milk influences the intestinal microbiota colonization of preterm infants. This is a pioneer study developed in collaboration with the country’s Human Milk Bank. We also expect to find microbiota alterations in infants according to the mode of delivery and to maternal diet. This study will contribute to increase the evidence on the effects of breast or donor human milk and its fortification with a bovine protein-based fortifier on infant microbiota.

Objective: Human Milk Banking (HMB), which is improved and supported as an extension of national breastfeeding policies in many countries, is not approved by the majority of the Muslim communities due to the ethical problems, traditional beliefs, and attitudes. The purpose of this study is to identify the attitudes and views of Turkish women who have children regarding Human Milk Banking.\ Methods: This study, which was conducted in the Family Health Centers located in the districts of Istanbul, is populationbased and descriptive design. The participants were 1055 volunteer women who had at least one child. Data were collected through a 32-item questionnaire developed by the researchers in line with the related literature, considering the cultural practices and beliefs. The participants were interviewed with face to face by the researcher in their homes. Results: Of all the participants, 62.8% had knowledge about the human milk banking project. However, 63.8% of them stated they would not donate their milk to a baby in an intensive care unit while they were breastfeeding their own child. In addition, 78.6% said they would not receive support from a human milk bank for their baby who might be in an intensive care unit or who might not have access to breast milk for some other reason. The most important issue related to human milk banking, as stated by 46.8% of the participants, is that it is inappropriate according to Islamic beliefs (babies are believed to become milk siblings). Hence, 57.2% of the participants think that a human milk banking project would not be approved in Turkey. Conclusion: In human milk banks to be established in Muslim countries, we need to ensure that the mothers' milk will not be mixed and also develop a model where both donor and recipient can exchange information about each other.

This bachelor thesis is dedicated to banks of human milk and their purpose. The paper is divided into theoretical part, which describes the lactation's development, the composition of breast milk, techniques and advantages of breast feeding and a practical part. History of human milk banks, their function and utilization are also included. The practical part of this thesis consists of qualitative and quantitative research. Two research goals were set up - to get to know about specifics of work of the staff in human milk banks and to map the mothers' awareness of the possibility of human milk banks utilization after childbirth. In terms of the goal one, a research question was set: VO1: What are the specifics of work of the staff in human milk banks? In terms of the second goal, the hypothesis was set: H1: Are there any differences in awareness within mothers of babies who are born in term versus those who are born before the term of the possibility to utilize human milk banks? The qualitative research was done through questioning, in-depth interview method. The research sample was made up from the staff working in human milk banks, the interview was done with 4 workers. The interviews were transcribed and analysed thanks to "pen - paper" method. They were further divided into three categories and fifteen subcategories. The research question was set up: What are the specifics of work of the staff in human milk banks? The outcomes of the research showed that the staff in human milk banks are mostly working with the donors of breast milk, which is further being examined, pasteurized and frozen. The quantitative part was made through questionnaire in social media with the total number of 1000 respondents. The outcomes of the research were graphically represented and added by verbal comments. Hypothesis verification was done thanks to chi square test. The zero hypothesis was tested against the alternative hypothesis with the level of significance of 5 %. Afterwards the level of significance was compared with the final value from chi square test. The hypothesis H1 ended up with the result of < 0,1 %. This result means that the mothers of babies who are born before the term have bigger awareness about human milk banks. 91,2 % of respondents are sufficiently informed about the human milk banks. This bachelor thesis can be used as an informative source to women, students of midwifery as well as the source of information for various conferences.

Esta pesquisa objetivou identificar saberes prévios e avaliar os conhecimentos construídos considerando a participação em grupos educativos sobre aleitamento materno, assim como, analisar as interações, entre profissionais e gestantes, que propiciam a construção deste conhecimento a partir dos grupos. A pesquisa de avaliação diagnóstica, processual e somativa foi o método proposto e realizada com 90 gestantes participantes de um grupo educativo em um Banco de Leite Humano, no Rio de Janeiro. Os resultados analisados mostram que as gestantes construíram conhecimentos sobre o assunto (51,1%), algumas mantiveram saberes que já possuíam (36,6%) e na menor parte (12,2%) houve desconstrução de saberes. A complexidade do tema e as lacunas presentes na realização dos grupos orientaram a discussão. Como considerações finais propõe-se um deslocamento da educação bancária para a construtivista, priorizando uma pauta simplificada contendo informações elementares, permitindo que estes assuntos sejam tratados na medida em que são demandados.

The COVID-19 pandemic has drastically affected continuum of care throughout the life. To "bend the curve", regarding argument among all the research community whether positive or symptomatically suspected COVID-19 mother isolation can reduce the risk of transmission to new born. The recommendation is, infant and Mother's should be enabled to remain together and practice kangaroo mother care. Breastfeeding is most essential for an infant growth and development and maternal psychology, evidences till now supporting exclusive breastfeeding is been only been beneficiary and it will be an injustice to obstruct in the wake of this pandemic. The spread of active SARS-CoV-2 virus that can cause infection through breast milk and breastfeeding has not been detected so far.

Aufgrund der deutlich verbesserten Industriemilchprodukte war man in den 1960er/fruhen 70er Jahren in der BRD weitgehend davon uberzeugt, dass Muttermilch selbst fur das Gedeihen von Fruhgeborenen nicht mehr notwendig war. Heute steht die Uberlegenheit der Muttermilch wieder auser Frage und Fortschritte in der Neonatologie haben eine wachsende Zielgruppe geschaffen, fur die menschliche Milch deutliche Vorteile hat, besonders hinsichtlich eines verbesserten Outcomes. Aktuell lasst sich ein Comeback der Frauenmilchbanken (FMB) beobachten. Weltweit gibt es ca. 500, 15 in Deutschland. Bis in die 1960er Jahren war Muttermilch in der deutschen Padiatrie das bevorzugte Mittel gegen die Sauglingssterblichkeit. Um den Bedarf an Frauenmilch zu decken, propagierten Arzte im Kaiserreich und der Weimarer Republik das Stillen und nutzten in den Kliniken Ammen. Erste Frauenmilchsammelstellen (FMS) entstanden; in der NS-Zeit gab es Dutzende. Die DDR hielt an FMS fest, in der BRD wurden sie in den 70er Jahren geschlossen. Die Geschichte der FMB wurde nicht nur durch wissenschaftliche Erkenntnisse gepragt, sondern auch durch Kultur, Politik und Wirtschaft. Im Kampf gegen die Sauglingssterblichkeit vermischten sich im Kaiserreich und der Weimarer Republik soziale, nationale und eugenische Uberlegungen. In der NS-Zeit wurde Frauenmilch gezielt zur Starkung der „erbgesunden“ Teile der „deutschen Volksgemeinschaft“ eingesetzt. Massive Werbung der Babynahrungsindustrie in der BRD und offentliche Debatten uber Umweltgifte und HIV/AIDS verstarkten Zweifel an den Vorteilen der naturlichen Ernahrung. Die Planwirtschaft, das staatlich gelenkte Gesundheitssystem und die zensierten Medien trugen masgeblich dazu bei, dass die DDR an FMS festhielt.

Objective to compare hospital and health service usage costs of feeding low-birthweight (LBW) infants predominantly with their mother's milk, supplemented with donor milk, with donor milk and preterm formula. Design prospective matching study. Setting tertiary public perinatal centre, neonatal intensive care unit (NICU) and donor human milk bank. Participants 100LBW infants (Group I) fed predominantly with their mother's milk from the first hour of life, supplemented (mainly for the first week of life) with donor milk, were matched on a 1:1 basis with 100LBW infants (Group II) who were fed with donor milk for the first 3 weeks of life followed by preterm formula until hospital discharge. Individualised targeted fortification of human milk was implemented in both study groups. Findings the costs of hospitalisation, doctor visits and prescription drugs for viral infections until 8 months of age were calculated for each infant. Infants fed predominantly with their mother's milk had significantly shorter hospital stays and lower hospitalisation costs. In Group I infants, the duration of enteral gavage feeding was shorter, resulting in significantly lower costs. Up to 8 months of age, Group I infants experienced fewer episodes of viral infections, and the cost of each doctor visit and drug prescription was lower for these infants. Conclusions feeding LBW infants predominantly with their mother's milk reduces hospital and health service usage costs. Implications for practice feeding LBW infants predominantly with their mother's milk, supplemented with donor milk, followed by exclusive breast feeding seems to result in potential savings in hospital and health service usage costs.

Background:The use of illegal drugs and tobacco is an exclusion criteria for accepting a nursing mother as a milk donor. The detection window for human milk testing is typically a few hours. Hair testing has been considered the gold standard to assess chronic exposure to these toxic substances.Objective:The aim of this study was to determine the levels of illegal drugs, nicotine, and caffeine in breast milk and hair samples from donors to assess whether these substances were being used during the donation period and the months leading up to it.Methods:Thirty-six samples of hair and breast milk were obtained from 36 donors. The tests performed identified nicotine, caffeine, morphine, cocaine, cannabis, amphetamines, codeine, methadone, and other substances derived therefrom.Results:No illegal drugs were found in any of the samples analyzed. Nicotine and cotinine were found in 33.3% (12/36) of all hair samples. Among these 12 samples, 10 had cotinine concentrations consistent with cutoff values for unexposed nonsmokers, 1 had concentrations consistent with cutoff values for passive smokers, and 1 had concentrations consistent with cutoff values for active smokers. Caffeine was found in 77.7% of the hair samples and in 50% of the donor milk samples. The correlation for caffeine between donor milk and hair samples was r = 0.288, P = .0881.Conclusion:Donors do not use illegal drugs during either the donation period or the months leading up to it. They are occasionally exposed to tobacco smoke and almost all of them consume caffeine.

Background:Milk safety is an important concern in neonatal units and human milk banks. Therefore, evidence-based recommendations regarding raw milk handling and storage are needed to safely promote supplying hospitalized infants with their mother’s own milk.Objectives:To evaluate raw human milk storage methods according to Brazilian milk management regulations by investigating the effects of refrigeration (5°C) for 12 hours and freezing (–20°C) for 15 days on the acidity and energy content in a large number of raw milk samples.Methods:Expressed milk samples from 100 distinct donors were collected in glass bottles. Each sample was separated into 3 equal portions that were analyzed at room temperature and after either 12 hours of refrigeration or 15 days of freezing. Milk acidity and energy content were determined by Dornic titration and creamatocrit technique, respectively.Results:All samples showed Dornic acidity values within the established acceptable limit (≤ 8°D), as required by Brazilian regulations. In addition, energy content did not significantly differ among fresh, refrigerated and frozen milk samples (median of ~50 kcal/100 mL for each).Conclusion:Most samples tested (> 80%) were considered top quality milk (< 4°D) based on acidity values, and milk energy content was preserved after storage. We conclude that the storage methods required by Brazilian regulations are suitable to ensure milk safety and energy content of stored milk when supplied to neonates.

UNLABELLED The development of human milk banks in Muslim countries is challenging because of the tradition of milk kinship. In other countries, this tradition imposes restrictions on Muslim mothers with regard to donating their milk or receiving donor milk for their preterm baby. However, Muslim law does allow the use of donated human milk under certain conditions, for example if it comes from a single known donor or is pooled from the milk of at least three donors. CONCLUSION Muslim parents need to be made aware that human milk banks can be used for preterm babies if strict conditions are met.

Background: Although human milk banking in India was started in 1984, limited data regarding bacteriological quality of milk are available. Objective: To find bacteriological contamination of milk samples in human milk bank. Methods: Retrospective analysis of milk samples from milk bank for the year 2009-2015 was done. Group A donor mothers were from postnatal or neonatal units of our hospital. Group B mothers were from milk donation camps organized at the community level. All milk samples were plated on blood agar for bacteriological analysis. Pre-pasteurized samples were analyzed for the year 2014-2015 only. Results: Total donor mothers were 3670. 1481 (40%) were from milk donation camp at the community level. 327 (9%) were preterm milk. 2.34% of post-pasteurized samples showed contamination as compared to 9.1% pre-pasteurized milk samples (p=0.002). Group A mothers showed a higher contamination rate as compared to Group B mothers in both pre-pasteurized (p

Objetivo: Identificar a influência dos bicos artificiais na amamentação das crianças atendidas em um Banco de Leite Humano (BLH) de um Hospital Amigo da Criança em um município de Pernambuco. Métodos: Estudo retrospectivo de corte transversal com abordagem quantitativa com uma amostra de 413 atendimentos. No tratamento estatístico foi utilizada a análise uni e bivariada para obtenção da distribuição dos valores de frequência absoluta e relativa e o teste Qui-quadrado na associação das variáveis a fim de determinar o p-valor. Resultados: Quase todas as puérperas realizaram acompanhamento pré-natal (99,5%), porém apenas 33,4% receberam orientações sobre amamentação durante as consultas. As crianças do estudo tinham em média 13,61 dias de vida e 38,7% já haviam utilizado bicos artificiais, com maior prevalência das chupetas, verificando que esses bicos influenciaram na pega incorreta e problemas com a mama. Conclusão: O baixo percentual de orientações sobre amamentação no pré-natal pode ter favorecido ao aumento do percentual de utilização de bicos artificiais, desta forma é de suma importância que haja enfermeiros qualificados para atuar junto à gestante/puérpera no processo de educação em saúde, afim de reduzir os efeitos deletérios desta prática.

Este estudo foi realizado para analisar o perfil lipídico, concentração de calorias, de sódio e água em amostras de colostro, leite de transição e leite maduro, para avaliar se as diferentes fases do leite humano são adequadas para serem oferecidas aos neonatos desidratados a termo. Foi escolhido delineamento transversal e quantitativo, utilizando 44 amostras de leite humano doados para o Banco de Leite Humano. Como critério de inclusão, foram selecionadas amostras de doadoras que amamentavam exclusivamente. Para avaliação dos perfis lipídicos foram preparados pools das três fases, que foram analisados com auxílio de espectrometria de massas com fonte de ionização por eletropulverização. As análises do teor calórico, sódio e umidade foram realizadas em amostras individuais utilizando-se metodologias oficiais da AOAC. Os perfis lipídicos indicaram que os pools podem apresentar importantes ácidos graxos que compõe os triglicerídeos presentes nos lipídios do leite humano. Os teores de sódio quando avaliados individualmente variaram significativamente e na maioria das amostras foram elevados, quando comparados aos valores de referência utilizados em UTIs neonatais. O teor médio de umidade do leite maduro foi maior quando comparado as demais fases, que apresentaram maiores teores de sódio e menores de umidade (p

Objetivo : Relatar a experiencia das enfermeiras do banco de leite humano (BLH) da Santa Casa de Misericordia de Sao Paulo, demonstrar as novas atribuicoes, descrever as repercussoes destas mudancas e avaliar o volume de leite coletado. Metodo: Estudo transversal, descritivo e analitico. Os dados foram coletados dos arquivos de registros do BLH desta instituicao, de 2016 a 2018. Resultado: Apos inicio de um projeto com atividades educativas voltadas a divulgacao da atuacao do BLH, observamos o aumento do numero de doadoras de leite materno e, consequentemente, melhoria no fornecimento de leite humano pasteurizado aos prematuros internados. No ano de 2016 os atendimentos somaram 2821 maes, e em 2018, 3238 (demonstrando um aumento de 15% no periodo). No tocante ao volume de leite coletado, foram 278,65 litros em 2016, contra 370,91 litros em 2018; demonstrando um aumento de 33%. Conclusao : As acoes de acolhimento, marketing, socializacao e busca ativa realizadas favoreceram o aumento do numero de doadoras de leite materno e no volume de leite coletado, bem como sua fidelizacao. A ampliacao das atividades levou a um importante espaco de atuacao do enfermeiro que trabalha no BLH. Palavras-chave : Aleitamento materno, Banco de leite, Enfermagem obstetrica ABSTRACT Objective : To report an experience lived by the nurses of the human milk bank (HMB) of Santa Casa de Misericordia de Sao Paulo, demonstrate the new attributions, describe the repercussions of these changes and evaluate the amount of appointments and milk volume collected from 2016 to 2018. Method: It was a cross-sectional descriptive and analytical study. Results: After beginning a project with educational activities aimed disseminating the HMB, culminating in the increase in the number of breast milk donors and, consequently, in the milk provision (more regular) for hospitalized premature newborns. The total number of attendances jumped from 2821 in 2016 to 3238 in 2018 (an increase of 15%). Regarding the volume of collected milk, we got 278,65 liters in 2016 against 370,91 liters in 2018 (an increase of 33 %). Conclusion: The actions of reception, marketing, socialization and the active search performed favored an increase in the number of breast milk donors and in the volume of collected milk, and to keep their loyalty. The expansion of these activities led to an important new field of nurses activities on the HMB. Key words: Breast feeding, Milk banks, obstetric nursing