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Professor Joao Aprigio Guerra de Almeida graduated in Food Engineering (UFV-1981) with a Master in Microbiology (UFV-1986) and a doctorate in Women's and Children's Health (Fiocruz/IFF, 1998) He is founder and coordinator of the Brazilian Human Milk Banks Network (Ministry of Health-Brasil/Oswaldo Cruz Foundation-Fiocruz, 1987 to 2024); Head of the National Reference Center for Human Milk Banks at the National Institute of Women, Children and Adolescent Health Fernandes Figueira-IFF (Fiocruz/IFF, 1987 to 2024); Executive Secretary of the Ibero-American Human Milk Banks Network Program (Ibero-American General Secretariat-SEGIB/Brazilian Cooperation Agency-ABC/MS-FIOCRUZ, 2008 to 2020); Coordinator of International Technical Cooperation in Human Milk Banks ABC/Fiocruz/MS (2005 to 2024); and Coordinator of the Human Milk Banks Network of the Community of Portuguese Speaking Countries – CPLP (2017 to 2024). He has been recognized with the Sasakawa Health Prize (World Health Organization [WHO], 2001); as Officer of the Order of Rio Branco (Presidency of the Federative Republic of Brazil, 2001); with Global Health Challenges and Responses of the South in Time of Crisis (WHO, 2009); as Commendator of the Order of Rio Branco-Ministry of Foreign Affairs/Presidency of the Federative Republic of Brazil (2018); and Dr LEE Jong-wook Memorial Prize for Public Health (WHO, 2020). His areas of activity include Public Health, breastfeeding, Human Milk Banks, Public Management, and International Technical Cooperation. [ABSTRACT FROM AUTHOR]

Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross‐sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom–70% vs. United States ‐ 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting‐specific milk banking research. Key messages: Milk bank donors in the United Kingdom and the United States reported primarily receiving milk banking information from the internet and not their health care provider.A substantial portion of human milk bank donors in the United Kingdom and the United States participate in other forms of milk exchange, including sharing with a peer.Participating in other forms of milk exchange did not predict lower milk bank donation volumes.Barriers to donation and predictors of donation volume differed between donors in the United Kingdom and the United States, suggesting setting‐specific research is warranted to improve the donation process globally. [ABSTRACT FROM AUTHOR]

Background: Human milk banks have been established to provide human milk to preterm infants who are unable to obtain milk from their mothers. Donor screening methods vary, and prospective donors are commonly screened for drug and recreational substance use through behavioral screening. Although the risk of illegal drug consumption in Japan is extremely low, caffeine may be consumed unknowingly and can be found in human milk. To date, only a few reports have been conducted on the concentration of caffeine in donor milk. Research Aim: This study aimed to examine the pre-pasteurization levels of caffeine in human milk donated to a milk bank in Japan. Methods: This was a cross-sectional, observational study of caffeine concentrations in human milk donated to a human milk bank in Japan. Caffeine concentration in the donor milk was measured using high-performance liquid chromatography. Results: Caffeine was detected in 70% of the donor milk samples (N = 350). The median (range) of caffeine concentration was 0.46 [< 0.10, 7.54] mg/L, and 64.0% of the samples had less than 1 mg/L of caffeine. The caffeine concentration varied widely among as well as within individuals. Conclusion: The average caffeine concentration in Japanese donor milk samples was higher than that previously reported in samples from Spain, but the range was similar. Donors should be informed that caffeine intake should be within a moderate range, to further increase the safety of donor milk. [ABSTRACT FROM AUTHOR]

IntroductionIn recent years, Poland has faced two major emergencies: the COVID-19 pandemic, a global-scale public health emergency in 2020, and the outbreak of a full-scale war in Ukraine, which forced over 9 million Ukrainians–mostly women and children–to flee from their country through the Polish–Ukrainian border in 2022.MethodsIn 2020 and 2022, we conducted two online questionnaires with human milk bank personnel to assess the impact of these emergencies on the human milk banking sector and its preparedness to face them. All 16 human milk bank entities operating in Poland were contacted and invited to participate in the study. For the first questionnaire, which was distributed in 2020, we obtained a 100% response rate. For the second questionnaire, the response rate was 88%, i.e., 14 out of 16 human milk banks completed the questionnaire. We compared these two emergencies in terms of the extent to which the potential of the Polish human milk bank network was exploited to support vulnerable infants who were not breastfed.Results and discussionOur findings indicate that recommendations to provide donor human milk to infants separated from their mothers during the COVID-19 pandemic were never fully implemented. Meanwhile, during the refugee crisis, national legislation allowing equal access to public healthcare for Ukrainian citizens were rapidly implemented, enabling a more effective response by human milk banks to support vulnerable infants. However, no specific measures were introduced to support refugees outside the standard criteria for donor human milk provision. Our results highlight the limited response from the sector during emergencies and the underutilization of the potential of a nationwide network of professional human milk banks. Drawing on Polish experiences, we emphasize the importance of having procedures and legal regulations regarding human milk banking in place even in non-crisis settings, which would facilitate a rapid emergency response. We also emphasize the need to include the implementation of emergency procedures in building a strong and resilient human milk banking system.

Abstract Pasteurised donor human milk is recommended for very low birthweight infants who do not have access to their mother's milk. Although the use of donor milk continues to increase, little is known about the donation experiences of milk bank donors. We aimed to describe and compare enablers, barriers and patterns of human milk donation and identify factors predicting donation volume in a convenience sample of approved milk bank donors in the United Kingdom and the United States. A cross‐sectional online survey was conducted from August 2022 to December 2022. Approved milk bank donors (n = 556) from three milk banks in the United States (n = 369, Mothers' Milk Bank of Florida, Mother's Milk Bank of North Texas and Northwest Mothers Milk Bank) and one milk bank in the United Kingdom (n = 187, Hearts Milk Bank) completed the survey. A substantial portion of donors in both settings reported participating in other forms of milk exchange (51% of U.S. donors vs. 39% of UK donors, p = 0.009). Top donation barriers reported in both settings were completing the serological screening and having enough space to store collected milk. Most donors started donating when their infant was 3 months old or older and reported donating mature milk. The most common source of information related to milk banking in each setting was the internet (United Kingdom–70% vs. United States ‐ 63%, p = 0.112). Variables that predicted lifetime donation volume differed between the United States and the United Kingdom, highlighting the importance of setting‐specific milk banking research.

This article presents the findings of a study on milk sharing and human milk banking in the southeastern Anatolia region of Turkey. The study found that while many participants were aware of wet nursing, a significant number were unaware of human milk banking and expressed reluctance to donate or feed their babies banked milk. Factors influencing their opinions included religious concerns, commercial gain, hygiene, and perceived decrease in nutritional value. The study suggests that healthcare professionals should consider these factors when planning educational programs to address negative attitudes towards human milk banking. The study also identified barriers and facilitators to the establishment of human milk banking and highlighted the value of milk sharing in meeting the needs of babies in need. The authors recommend implementing educational programs and providing guidance to mothers to address concerns and promote the benefits of human milk banking. [Extracted from the article]

Abstract Background Donated breast milk is considered beneficial to vulnerable infants. Thus, Uganda launched its first human milk bank in November 2021 to provide breast milk to preterm, low birthweight and sick babies. However, there is a scarcity of information on the acceptability of donated breast milk in Uganda. The study sought to assess the acceptability of using donated breast milk and associated factors among pregnant women at a private and a public hospital in central Uganda. Methods This cross-sectional study enrolled pregnant women attending antenatal care at the selected hospitals between July and October 2020. All pregnant women recruited had already given birth to at least one child. Data were collected using a semi-structured questionnaire, and we recruited participants through systematic sampling. Used frequencies, percentages and means with standard deviations to summarize variables. Assessed the association between the acceptability of donated milk and selected factors by comparing their arithmetic means using a generalized linear model to allow for clustering at the health facility level. Used a normal distribution and an identity link and calculated the adjusted mean differences together with 95% CIs [generated using robust variance estimators to correct for model misspecification]. Results A total of 244 pregnant women with a mean age of 30 (± 5.25) years were enrolled. Sixty-one-point 5% (150/244) of the women reported that they would accept donated breast milk. Higher education (adjusted mean difference, technical versus primary level: 1.33; 95% CI 0.64, 2.02), being Muslim (adjusted mean difference, Muslim versus Christian: 1.24; 95% CI 0.77, 1.70), having heard of donated breast milk banking (adjusted mean difference, ever versus never: 0.62; 95% CI 0.18, 1.06) and presence of a serious medical condition (adjusted mean difference, preference of donated milk versus other feeds in a serious medical condition: 3.96; 95% CI, 3.28, 4.64) were associated with acceptability of donated breast milk. Conclusions The acceptability of using donated breast milk for infant feeding was high among pregnant women. Public sensitization and education campaigns are indispensable for the acceptability of donated milk. These programs should be designed to include women with lower education levels.

Abstract Background Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda. Methods A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0. Results A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother’s milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child. Conclusion In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk.

There is a growing recognition globally that care regarding lactation following a perinatal death needs to potentially offer the opportunity for maternal donation. This article discusses this experience and perspectives from a human milk bank (HMB) in Vietnam. This is a descriptive exploratory case study that has a long tradition in both the social and health sciences. Triangulated data collection involved a review of video data, interview data with the donor, and data review for the Da Nang HMB, a Center for Excellence in Breastfeeding. We found that although it is common for mothers in Vietnam to donate breastmilk to HMBs, it is less common for this to occur following perinatal loss. We offer a descriptive case study of the maternal loss of twins and a subsequent choice to donate for approximately 1 month to the Da Nang HMB, the first HMB in Vietnam. We discuss four reasons derived from this case regarding donation following perinatal loss. (1) A strong motivation to donate breastmilk when aware of the service, (2) donating breastmilk helped her deal with grief, (3) family members supported her through this tough time and supported her decision, and (4) health staff supported her decision. While human milk sharing (e.g., wet nursing) has been practiced in Vietnam, breastmilk donation from bereaved mothers has neither been discussed nor well-researched. Because maternal grief is complex and individual, deciding to donate breastmilk is a personal decision that needs to be supported, without creating guilt for those who do not wish to donate.

Cold is indispensable when preserving breast milk for later use in ordinary breastfeeding practices and, in addition to other devices such as the breast pump, fridges and freezers have been essential in making human milk a mobile biosubstance. Cryotechnologies become even more important when donated milk has to be preserved for the feeding of hospitalized babies or when, in the form of milk probiotics, it enters the realms of scientific research and industrial production. However, attention to cold only offers one side of the picture, as thawing and heating are essential processes in human milk circulation too. Drawing on research on milk banking practices in Spain, we present three instances where technologies of cold and heat are applied to human milk or its components: hospital banks that collect milk from donors; the practices of lactating women who donate part of their milk to hospital banks, share it informally with other women, or participate in clinical research; and biopharmaceutical companies developing cutting-edge nutritional products employing microbial strains obtained from breast milk. Each of these scenarios resorts to different technological manipulations of cold and heat, generating distinct thermal assemblages where technical questions and sociocultural logics are simultaneously at stake. [ABSTRACT FROM AUTHOR]

Abstract Background Human milk banks (HMB) play an essential role by providing human milk to infants who would otherwise not be able to receive mother’s milk. There is currently no donor milk bank in Turkey. For any new health intervention to be successful, determining its acceptability is a vital first step. This study intends to determine the opinions, knowledge, and attitudes of native Turkish and refugee women living in Çeştepe, Aydın, a rural area in Turkey, about HMB. Methods A population-based cross-sectional, mixed-methods study was conducted. Qualitative study data were collected through in-depth interviews with 33 women, and quantitative study data were collected using a questionnaire. A total of 271 women in the region were included in the study. Qualitative data were thematically analyzed and then a conceptual framework was created. Logistic regression was performed for quantitative data. Results Fifty-seven point nine per cent of the women were willing to donate breast milk, whereas only 27.7% were willing to use donor milk for their babies. Religious concerns, fear of infectious diseases, and distrust in people they did not know were among the reasons for the negative attitudes of the women. Fear of infectious diseases was mentioned specifically by native Turkish women, and religious concerns were reported both by native Turkish and refugee women. The importance of breast milk and religion were among the reasons for positive attitudes. Additionally, odds of having a positive attitude were 4.19 times higher in homemaker women (95% CI 2.0, 8.76); 4.77 times higher in women with three or more children (95% CI 1.25, 8.15); 6.12 times higher in women who had a positive attitude towards wet nursing (95% CI 3.14, 9.63); and 2.68 times higher in those who had previously heard about human milk banking (95% CI 1.24, 5.79). Conclusion Attitudes towards HMB are affected by religion, cultural beliefs, and concerns about the safety of breast milk in HMBs. Refugees and native Turkish women are found to have similar religious concerns. These findings should be taken into consideration in human milk banking initiatives and in activities to increase acceptance by the public.

Background: Donated breast milk is considered beneficial to vulnerable infants. Thus, Uganda launched its first human milk bank in November 2021 to provide breast milk to preterm, low birthweight and sick babies. However, there is a scarcity of information on the acceptability of donated breast milk in Uganda. The study sought to assess the acceptability of using donated breast milk and associated factors among pregnant women at a private and a public hospital in central Uganda. Methods: This cross-sectional study enrolled pregnant women attending antenatal care at the selected hospitals between July and October 2020. All pregnant women recruited had already given birth to at least one child. Data were collected using a semi-structured questionnaire, and we recruited participants through systematic sampling. Used frequencies, percentages and means with standard deviations to summarize variables. Assessed the association between the acceptability of donated milk and selected factors by comparing their arithmetic means using a generalized linear model to allow for clustering at the health facility level. Used a normal distribution and an identity link and calculated the adjusted mean differences together with 95% CIs [generated using robust variance estimators to correct for model misspecification]. Results: A total of 244 pregnant women with a mean age of 30 (± 5.25) years were enrolled. Sixty-one-point 5% (150/244) of the women reported that they would accept donated breast milk. Higher education (adjusted mean difference, technical versus primary level: 1.33; 95% CI 0.64, 2.02), being Muslim (adjusted mean difference, Muslim versus Christian: 1.24; 95% CI 0.77, 1.70), having heard of donated breast milk banking (adjusted mean difference, ever versus never: 0.62; 95% CI 0.18, 1.06) and presence of a serious medical condition (adjusted mean difference, preference of donated milk versus other feeds in a serious medical condition: 3.96; 95% CI, 3.28, 4.64) were associated with acceptability of donated breast milk. Conclusions: The acceptability of using donated breast milk for infant feeding was high among pregnant women. Public sensitization and education campaigns are indispensable for the acceptability of donated milk. These programs should be designed to include women with lower education levels. [ABSTRACT FROM AUTHOR]

Background: Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda. Methods: A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0. Results: A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother’s milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child. Conclusion: In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk. [ABSTRACT FROM AUTHOR]

Background: The most utilized pasteurization method in donor human milk banks is Holder pasteurization (heating 62.5 °C for 30 min). However, many bioactive proteins are heat sensitive and are inactivated. Research Aim: To determine the results of a range of heating regimes on the activities of xanthine oxidase, lactoperoxidase and lysozyme, the concentrations of immunoglobulin A and lactoferrin, as well as bacterial inactivation. Method: This prospective, cross-sectional, intervention study was designed to measure the influence of heating temperatures on bioactive components in donor human milk. Milk samples were processed at 40, 50, 55, 62.5, 75, 127 °C and the activities of the enzymes, and the concentration of immune proteins, were measured. Results: No bacterial colonies were detectable, using standard culture methods, after heating above 50 ºC. All proteins studied retained over 60% concentrations or activities when the pasteurization temperature was 50 ºC or lower, while their concentrations or activities were lost at higher temperatures. For lactoferrin, the residual concentration was above 80% when heating temperature was under 55 °C, while only 20% remained after Holder pasteurization. Both xanthine oxidase and lactoperoxidase had little residual activity when temperatures were above Holder pasteurization. Lysozyme retained a greater proportion of residual activity than other proteins, following heating at all temperatures. Conclusions: The concentrations or activities of immune proteins and bioactive enzymes decreased when heated above 50 °C. The results of this study can be used to design temperature control guidance during alternative methods of pasteurization. [ABSTRACT FROM AUTHOR]

BackgroundAlthough political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB.MethodsQuantitative and qualitative responses were received from Ghanaian females (n = 1,270) aged 18+ years. Excluding outliers and missing data (n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses.ResultsIn our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre (n = 47), (ii) fear of infections (n = 15), (iii) religious beliefs (n = 9), and (iv) insufficient information (n = 24). This study serves as the first step toward the development of a HMB in Ghana.ConclusionsOverall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality.

Background: The use of human milk provides substantial short- and long-term benefits. With the establishment of the first donor human milk bank in Singapore, high-risk preterm and critically ill infants whose mothers have an inadequate milk supply can have access to pasteurized donor human milk. Materials and Methods: A self-administered anonymous questionnaire was conducted among doctors and nurses working in the special care unit and neonatal intensive care unit of KK Women's and Children's Hospital. The questionnaire was divided into three main sections, namely, demographics, knowledge assessment, and opinion. The aims of the survey were to assess the knowledge, attitudes, and perceptions of health-care workers on breast milk donation and milk bank, and to identify any differing perceptions among different racial and ethnic groups. Results: A total of 38 doctors and 140 nurses from various racial and religious backgrounds participated in this survey. More than 50% of respondents know the benefits of breast milk over formula milk; however, knowledge of the milk donation process and the effect of pasteurization on donated breast milk can be improved on. In the opinion section, 78.7% of survey respondents were supportive of the human milk bank. Sixty-eight (38.2%) respondents felt that recipients should receive milk from donors of the same race and ethnicity, whereas 56 (31.5%) disagreed and 53 (30%) were neutral. Conclusion: Donor human milk banking is well received and supported by health-care workers. Knowledge of milk donation, screening, pasteurization, and storage can be improved on. Further evaluation is required to determine the underlying concerns that different ethnic groups may have. [ABSTRACT FROM AUTHOR]

This article is based on the contents of 'Dr. K. C. Chaudhuri Lifetime Achievement Award Oration' delivered on the Indian Journal of Pediatrics Annual Day 2022. The author shares glimpses of his academic journey from a remote village to a central Institute. This includes his career as a medical teacher and developing the Department of Neonatology at JIPMER, Pondicherry. This article is primarily focused on some of the significant research conducted during his tenure, like perinatal asphyxia, therapeutic hypothermia, neonatal sepsis, intrauterine growth restriction, and human milk banking. [ABSTRACT FROM AUTHOR]

Introduction: Human milk banking (HMB) is a service established for collection, screening, processing, storage, and distribution of donated human milk. HMB is the best way of ensuring a safe supply of human milk to all the needy neonates. It helps to decrease infections, neonatal sepsis, and necrotizing enterocolitis, thus reduces neonatal morbidity and mortality. Methodology: This is a short-term student research project conducted as an observational, comparative, cross-sectional study. It was conducted in the neonatal intensive care unit (NICU) and HMB of a tertiary care hospital in a metropolitan city, conducted after approval from the Ethics Committee of the Institute. A total of 50 neonates from the NICU who had received pasteurized donor human milk (PDHM) were enrolled in one group (Group I – PDHM). The data of 50 newborns from NICU of the same institute were also collected retrograded for comparison before the establishment of HMB, as they had not received PDHM and enrolled in another group (Group II – non-PDHM). Results: It was observed that in Group I (PDHM), 55% of neonates were full term and 42.5% were preterm, and in Group II, 45% were full terms and 57.5% were preterm. Sepsis was seen in 30% of Group 1 and 54% of Group 2 and hyperbilirubinemia was seen in 22% of Group 1 and 42% of Group 2. There was a 24% decrease in sepsis and 20% decrease in hyperbilirubinemia in PDHM group. Mortality was seen in 40% of Group 1 and 60% of Group 2. A decrease in mortality was seen in PDHM group. Conclusions: HMB is imperative for the reduction of neonatal morbidity and mortality. It is a feasible, cost-effective option and a boon for neonates, particularly in developing countries like India.

Background: Human milk banks (HMB) play an essential role by providing human milk to infants who would otherwise not be able to receive mother's milk. There is currently no donor milk bank in Turkey. For any new health intervention to be successful, determining its acceptability is a vital first step. This study intends to determine the opinions, knowledge, and attitudes of native Turkish and refugee women living in Çeştepe, Aydın, a rural area in Turkey, about HMB. Methods: A population-based cross-sectional, mixed-methods study was conducted. Qualitative study data were collected through in-depth interviews with 33 women, and quantitative study data were collected using a questionnaire. A total of 271 women in the region were included in the study. Qualitative data were thematically analyzed and then a conceptual framework was created. Logistic regression was performed for quantitative data. Results: Fifty-seven point nine per cent of the women were willing to donate breast milk, whereas only 27.7% were willing to use donor milk for their babies. Religious concerns, fear of infectious diseases, and distrust in people they did not know were among the reasons for the negative attitudes of the women. Fear of infectious diseases was mentioned specifically by native Turkish women, and religious concerns were reported both by native Turkish and refugee women. The importance of breast milk and religion were among the reasons for positive attitudes. Additionally, odds of having a positive attitude were 4.19 times higher in homemaker women (95% CI 2.0, 8.76); 4.77 times higher in women with three or more children (95% CI 1.25, 8.15); 6.12 times higher in women who had a positive attitude towards wet nursing (95% CI 3.14, 9.63); and 2.68 times higher in those who had previously heard about human milk banking (95% CI 1.24, 5.79). Conclusion: Attitudes towards HMB are affected by religion, cultural beliefs, and concerns about the safety of breast milk in HMBs. Refugees and native Turkish women are found to have similar religious concerns. These findings should be taken into consideration in human milk banking initiatives and in activities to increase acceptance by the public. [ABSTRACT FROM AUTHOR]

Background Breastfeeding is crucial for infant health, but not all mothers can breastfeed due to various constraints. Making human milk banks (HMBs) is essential for providing donor milk to preterm and sick infants. Methods  This is a cross-sectional study at Shri BM Patil Medical College Hospital and Research Centre in Vijayapura involving 420 lactating mothers. Convenience sampling and semi-standardized interviews were used to assess socio-demographics, maternal factors, and attitudes toward milk donation. Results Among the 420 lactating mothers surveyed, urban mothers were significantly more likely to have received breastfeeding counseling (56.7% vs. 41.4%) and were more aware of milk bank donations (20.0% vs. 11.4%) than rural mothers. Logistic regression analysis revealed that urban residence, higher education, and prior knowledge of milk donation were significant predictors of willingness to donate breast milk. Conclusion The findings emphasize the importance of education and awareness, particularly in rural areas, to promote milk donation. Addressing socio-economic disparities and sharing personal experiences can also encourage donations. Targeted educational programs are crucial for enhancing donation rates and improving newborn health outcomes, making milk donation a vital area for public health initiatives., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethical Clearance Committee BLDE(Deemed to be University) issued approval BLDE(DU)/IEC/651/2022-23. The University's ethical committee scrutinized the synopsis on 26 August 2022 in the Department of Pharmacology, and the original revised version of the synopsis has been accorded ethical clearance. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bodi Jayakrishna et al.)

Introduction: Human milk banking (HMB) is a service established for collection, screening, processing, storage, and distribution of donated human milk. HMB is the best way of ensuring a safe supply of human milk to all the needy neonates. It helps to decrease infections, neonatal sepsis, and necrotizing enterocolitis, thus reduces neonatal morbidity and mortality. Methodology: This is a short-term student research project conducted as an observational, comparative, cross-sectional study. It was conducted in the neonatal intensive care unit (NICU) and HMB of a tertiary care hospital in a metropolitan city, conducted after approval from the Ethics Committee of the Institute. A total of 50 neonates from the NICU who had received pasteurized donor human milk (PDHM) were enrolled in one group (Group I – PDHM). The data of 50 newborns from NICU of the same institute were also collected retrograded for comparison before the establishment of HMB, as they had not received PDHM and enrolled in another group (Group II – non-PDHM). Results: It was observed that in Group I (PDHM), 55% of neonates were full term and 42.5% were preterm, and in Group II, 45% were full terms and 57.5% were preterm. Sepsis was seen in 30% of Group 1 and 54% of Group 2 and hyperbilirubinemia was seen in 22% of Group 1 and 42% of Group 2. There was a 24% decrease in sepsis and 20% decrease in hyperbilirubinemia in PDHM group. Mortality was seen in 40% of Group 1 and 60% of Group 2. A decrease in mortality was seen in PDHM group. Conclusions: HMB is imperative for the reduction of neonatal morbidity and mortality. It is a feasible, cost-effective option and a boon for neonates, particularly in developing countries like India. [ABSTRACT FROM AUTHOR]

Breastfeeding, use of pasteurised donor human milk when mother's own milk is unavailable and kangaroo mother care have independently proven benefits in improving survival of vulnerable sick babies. A triangulated approach called the Mother Baby Friendly Initiative Plus (MBFI+) model, bringing together the combined benefits of these proven interventions, was used to improve exclusive human milk feeding at health facilities through quality improvement and system strengthening approach. This quality improvement before-and-after uncontrolled study enrolled 5343 term and 278 very low birth weight (VLBW) mother-infant dyads. Pre- and post-intervention data were compared to evaluate effect on feeding-related healthcare processes and outcomes. Primary outcome which was incidence of exclusive human milk feeding during hospital stay, improved from 44 to 64.8% (RR 1.47, 95% CI: 1.40–1.55) among term and from 60.5 to 80.7% (RR: 1.33; 95% CI: 1.12–1.59) among VLBW neonates. Neonates receiving extended KMC improved from 43 to 71.1% (RR: 1.65; 95% CI: 1.30–2.10). Conclusion: MBFI+ approach improved exclusive human milk feeding among term and preterm VLBW neonates. What is Known: • Breastfeeding has immense health benefits to sick preterm neonates admitted in NICU. What is New: • Quality improvement approach can lead to system strengthening and can help overcome hindrances to achieve increased breastfeeding rates. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, Poland has faced two major emergencies: the COVID-19 pandemic, a global-scale public health emergency in 2020, and the outbreak of a full-scale war in Ukraine, which forced over 9 million Ukrainians-mostly women and children-to flee from their country through the Polish-Ukrainian border in 2022., Methods: In 2020 and 2022, we conducted two online questionnaires with human milk bank personnel to assess the impact of these emergencies on the human milk banking sector and its preparedness to face them. All 16 human milk bank entities operating in Poland were contacted and invited to participate in the study. For the first questionnaire, which was distributed in 2020, we obtained a 100% response rate. For the second questionnaire, the response rate was 88%, i.e., 14 out of 16 human milk banks completed the questionnaire. We compared these two emergencies in terms of the extent to which the potential of the Polish human milk bank network was exploited to support vulnerable infants who were not breastfed., Results and Discussion: Our findings indicate that recommendations to provide donor human milk to infants separated from their mothers during the COVID-19 pandemic were never fully implemented. Meanwhile, during the refugee crisis, national legislation allowing equal access to public healthcare for Ukrainian citizens were rapidly implemented, enabling a more effective response by human milk banks to support vulnerable infants. However, no specific measures were introduced to support refugees outside the standard criteria for donor human milk provision. Our results highlight the limited response from the sector during emergencies and the underutilization of the potential of a nationwide network of professional human milk banks. Drawing on Polish experiences, we emphasize the importance of having procedures and legal regulations regarding human milk banking in place even in non-crisis settings, which would facilitate a rapid emergency response. We also emphasize the need to include the implementation of emergency procedures in building a strong and resilient human milk banking system., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gawrońska, Sinkiewicz-Darol and Wesołowska.)

Background: Donor milk is the standard of care for hospitalized very low birth weight (VLBW) infants when mother's milk is unavailable; however, growth of donor milk-fed infants is frequently suboptimal. Variability in nutrient composition of donated milk complicates the production of a uniform pooled product and, subsequently, the provision of adequate nutrition to promote optimal growth and development of VLBW infants. We reasoned a machine learning approach to construct batches using characteristics of the milk donation might be an effective strategy in reducing the variability in donor milk product composition.Objective: The objective of this study was to identify whether machine learning models can accurately predict donor milk macronutrient content. We focused on predicting fat and protein, given their well-established importance in VLBW infant growth outcomes.Methods: Samples of donor milk, consisting of 272 individual donations and 61 pool samples, were collected from the Rogers Hixon Ontario Human Milk Bank and analyzed for macronutrient content. Four different machine learning models were constructed using independent variable groups associated with donations, donors, and donor-pumping practices. A baseline model was established using lactation stage and infant gestational status. Predictions were made for individual donations and resultant pools.Results: Machine learning models predicted protein of individual donations and pools with a mean absolute error (MAE) of 0.16 g/dL and 0.10 g/dL, respectively. Individual donation and pooled fat predictions had an MAE of 0.91 g/dL and 0.42 g/dL, respectively. At both the individual donation and pool levels, protein predictions were significantly more accurate than baseline, whereas fat predictions were competitive with baseline.Conclusions: Machine learning models can provide accurate predictions of macronutrient content in donor milk. The macronutrient content of pooled milk had a lower prediction error, reinforcing the value of pooling practices. Future research should examine how macronutrient content predictions can be used to facilitate milk bank pooling strategies. [ABSTRACT FROM AUTHOR]

Human milk is recommended as the optimal source of nutrition for babies up to six months of age, as it provides individualized, specific and abundant nutritional compounds, as well as immunological protection. Currently, there is wide interest in studying human milk because of this key role, as well as identification of biologically active compounds. In addition, human milk banks play an important role in supplying donor human milk to infants, especially premature infants, in hospitals, which involves processing and storage of such milk. This review summarises recent studies on macronutrients in human milk, including their structure, levels, influencing factors, and contributions to the health benefits of infants. Physico-chemical properties of human milk are also reviewed, including pH, colour, stability of casein micelles, size and zeta-potential of fat globules, heat stability, freeze-thaw effect, dehydration and phase separation, and the impact of preservation processes on these. The levels of human milk macronutrients and factors that influence these, such as lactation and gestational age, are ongoing research topics. Studies on physicochemical properties of some human milk components, such as caseins, are comparatively few, as research has mainly focused on bioactive peptides, milk fat globule membrane and human milk oligosaccharides. Processing and preservation are applied to human milk and the effects of these methods on the retention of human milk nutrients for use in human milk banks and hospitals must be considered. Some physico-chemical properties, such as milk pH, colour, and physical stability, may be possible indicators of milk quality. • Studies on the levels of macronutrients in human milk are summarized. • Physiochemical properties of human milk are reviewed. • Technologies for preservation of human milk, such as heating, high-pressure treatment and drying, are discussed. • Reports on the stability of human milk nutrients following such preservation steps are reviewed. [ABSTRACT FROM AUTHOR]

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Abstract Background The first priority for infant feeding is to encourage the use of infant’s mother’s breast milk, but when this is not possible, donated breast milk is the second best option. In developing countries, very few studies have been conducted on the acceptance of donor breast milk. Hence, this study was planned to discover the acceptability of donor breast milk banking, its use for feeding infants, and associated factors among mothers in eastern Ethiopia. Methods A mixed method study was conducted in eastern Ethiopia from December 2015 to February 2016. Data were collected through a pre-tested structured interview based questionnaire. A total of 1085 mothers participated in the survey and six focus group discussions were held with 33 mothers. Descriptive statistics have been used to report results from the survey and qualitative data were analyzed using the thematic data analysis approach. Results The study revealed that 119 (11%) of participants were willing to donate breast milk for banking and 165 (15.2%) of mothers were willing to use for feeding infants. The acceptance of donor milk banking was 5.8 times more likely among the mothers who had heard about donor milk banking previously (Adjusted Odds Ratio [AOR] 5.8; 95% Confidence Interval [CI] 3.1, 10.72), 4.2 times more likely among the mothers who heard about wet-nurses (AOR 4.2; 95% CI 2.5, 6.99) and 2 times more likely among mothers who had visited a neonatal intensive care unit (AOR 2; 95% CI 1.1, 3.73). Conclusions Generally, this study showed that the acceptance of breast milk donation for banking and its use for feeding infants was very low, due to lack of information and misconceptions about the safety of breast milk. Therefore, before initiation of any donor milk banking program awareness should be created about donor breast milk and its safety.

Introduction: Background: Breast milk is the perfect food and uniquely superior to, artificial baby milk. Giving a child breast milk from another woman is not a newer concept; wet nursing was a fairly common practice a few decades ago. Human milk banks are services which collect, screen, process and distribute donated breast milk. Current research evidences suggest that pasteurized donor human milk can provide many of the components and eliminate the risk of transmission of infectious agents. Method: Quantitative research approach was adopted to assess the knowledge on Human Milk Banking; a structured knowledge questionnaire was given to100 antenatal mothers. The study was conducted at Justice K.S Hegde charitable Hospital. Descriptive survey design was adopted to accomplish the objectives. Results: Findings revealed that 52% of mothers had good knowledge and remaining mothers had an average knowledge. The 'p' value of age with regards to knowledge on human milk banking is 0.099, whereas the 'p' value of parity is 0.718. Meanwhile the 'p' value of family is 0.213 and that of religion is 0.428. For education, occupation, income and any previous exposure with human milk banking the 'p' values were 0.284, 0.082, 0.104 and 0.750 respectively. The above results shows that for all the demographic characteristics, the 'p' value is >0.05. Hence it was found that there was no significant association between knowledge of antenatal mothers with selected demographic variables. Conclusion: Providing knowledge to antenatal mothers on human milk banking serve as an investment for the future needs. The nurse practitioner has a primary responsibility of enhancing the knowledge and developing positive attitude, towards utilization of human milk banking. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine the beliefs and opinions of breastfeeding mothers about human milk banking., Methods: This study was conducted as a case study, which is a qualitative research method. The population researched consisted of women who applied to the Gaziantep Health Care Family Health Center between June and December 2022. The sample included 30 mothers selected through purposive sampling. The data were collected using a descriptive characteristics form and a semistructured interview form. Ethical committee and institutional approvals were obtained. The data were analyzed using the MAXQDA qualitative research software program., Results: The majority of the breastfeeding mothers had limited knowledge about human milk banking and considered it religiously problematic. They held the belief that breastfeeding siblings should not marry each other on religious grounds. The mothers were willing to act as wet nurses in case of necessity, but they expressed a preference against having their own baby nursed by another woman. They also stated that they would consider using milk banks only if the information provided was limited to the mother and baby. Additionally, it was observed that if they found themselves in a difficult situation, they would only seek a wet nurse from their immediate social circle., Conclusion: The breastfeeding mothers expressed that milk banking was a beneficial practice; however, they had religious reservations about it. It was observed that they would be willing to donate their milk to these banks and use them in times of need under certain conditions. These conditions included ensuring that the milk is not mixed, providing information about the mother and baby to families, having babies of the same sex, and adhering to strict cleanliness and hygiene measures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

INTRODUCTION: Human milk banking is becoming widespread in many countries. In Turkey is a controversial topic with reasons, such as traditional and religious beliefs. The aim of this study was to investigate the knowledge and opinions of mothers on donor milk and milk banking. METHOD: This study was cross-sectional, descriptive and comparative. In the study between 1th of October-30th of December 2018, a total of 252 mothers who applied to the gynecology outpatient clinics of a state hospital volunteered to participate. Data were collected through face-to-face interviews. IBM SPSS Statistics 21 package program was used to evaluate the data. Ethical Committee and related consents were taken. RESULTS: The mean age of the mothers participating in the study was 33 ± 7,233 years and 47,6% had heard of the human milk bank before. 49,2% of the participants stated that they could advise other mothers to buy milk from the milk bank. However, 43,7% reported that they did not want to buy milk from their milk bank for their baby when they needed it. The mothers indicated that 67,9% of them were concerned about transmission of the disease as the reason for not wanting to benefit from the milk bank. 66,3% think that the milk banks would make sense if the family that gave milk and the milk was registered and recognized each other. DISCUSSION and CONCLUSION: The results of the study show similarities with our research, but the majority of mothers' lack of knowledge about donor milk and milk banks is more than the importance of religious and cultural beliefs. [ABSTRACT FROM AUTHOR]

Background: Human milk banks (HMB) have been established for over 100 years in North America and Europe. This study aimed to describe and summarize the operation and characteristics of the HMBs in mainland China since the first nonprofit HMB operated in 2013. Methods: Operation of HMB in mainland China is based on the standards and guidelines of the Human Milk Banking Association of North America and some countries in Europe and was modified to meet the needs and circumstances in China such as donation only in the local HMB by medical staff. We reviewed the descriptive data of these 14 HMBs and the clinical characteristics of recipients, the eligible milk donors and the donor milk retrospectively. Results: In mainland China, from March 2013 to December 2016, 14 nonprofit HMBs were developed and operational in public hospitals except one and located in the south, east, north and northwest of mainland China. In total, 2680 eligible donors donated 4608.2 L of breast milk. The mean age of these donors was 29.4 years with 60.6% receiving college education and 90.6% term delivery. A total of 4678 recipients including preterm infants (n = 2990, 63.9%), feeding intolerance (n = 711, 15.2%), maternal illness (n = 345, 7.4%), serious infection (n = 314, 6.7%), necrotising enterocolitis (n = 244, 5.2%), post-surgery (n = 38, 0.8%) and others (n = 36, 0.8%). The rate of discarded raw milk was only 4.4% because of hepatitis B and C or cytomegalovirus positivity. Conclusions: HMB has been developing rapidly in mainland China. Donor human milk was used not only for preterm infants but also for other ill children. But the sustainability of milk banking needs proper management and more financial support by relative health authorities and the government. [ABSTRACT FROM AUTHOR]

Background: Human milk oligosaccharides (HMOs) have important protective functions in human milk. A low-cost remote pasteurisation temperature-monitoring system has been designed using FoneAstra, a cell phone-based networked sensing system to monitor simulated flash heat pasteurisation. Aim: To compare the pasteurisation effect on HMOs of the FoneAstra FH method with the current Sterifeed Holder method used by human milk banks. Methods: Donor human milk samples (n = 48) were obtained from a human milk bank and pasteurised using the two pasteurisation methods. HMOs were purified from samples and labelled before separation using high-performance liquid chromatography. Concentrations of total HMOs, sialylated and fucosylated HMOs and individual HMOs using the two pasteurisation methods were compared using repeated-measures ANOVA. Results: The study demonstrated no difference in total concentration of HMOs between the two pasteurisation methods and a small but significant increase in the total concentration of HMOs regardless of pasteurisation methods compared with controls (unpasteurised samples) (p<0.0001). Conclusion: The FoneAstra FH pasteurisation system does not negatively affect oligosaccharides in human milk and therefore is a possible alternative for providing safely sterilised human milk for low- and middle-income countries. [ABSTRACT FROM AUTHOR]

A pasteurization temperature monitoring system has been designed using FoneAstra, a cellphone-based networked sensing system, to monitor simulated flash-heat (FH) pasteurization. This study compared the effect of the FoneAstra FH (F-FH) method with the Sterifeed Holder method currently used by human milk banks on human milk immune components (immunoglobulin A (IgA), lactoferrin activity, lysozyme activity, interleukin (IL)-8 and IL-10). Donor milk samples (N = 50) were obtained from a human milk bank, and pasteurized. Concentrations of IgA, IL-8, IL-10, lysozyme activity and lactoferrin activity were compared to their controls using the Student's t-test. Both methods demonstrated no destruction of interleukins. While the Holder method retained all lysozyme activity, the F-FH method only retained 78.4% activity (p < 0.0001), and both methods showed a decrease in lactoferrin activity (71.1% Holder vs. 38.6% F-FH; p < 0.0001) and a decrease in the retention of total IgA (78.9% Holder vs. 25.2% F-FH; p < 0.0001). Despite increased destruction of immune components compared to Holder pasteurization, the benefits of F-FH in terms of its low cost, feasibility, safety and retention of immune components make it a valuable resource in low-income countries for pasteurizing human milk, potentially saving infants' lives. [ABSTRACT FROM AUTHOR]

Human milk banks play an essential role by providing human milk to infants who would otherwise not be able to receive human milk. The largest group of recipients are premature infants who derive very substantial benefits from it. Human milk protects premature infants from necrotizing enterocolitis and from sepsis, two devastating medical conditions. Milk banks collect, screen, store, process, and distribute human milk. Donating women usually nurse their own infants and have a milk supply that exceeds their own infants' needs. Donor women are carefully selected and are screened for HIV-1, HIV-2, human T-cell leukemia virus 1 and 2, hepatitis B, hepatitis C, and syphilis. In the milk bank, handling, storing, processing, pooling, and bacterial screening follow standardized algorithms. Heat treatment of human milk diminishes anti-infective properties, cellular components, growth factors, and nutrients. However, the beneficial effects of donor milk remain significant and donor milk is still highly preferable in comparison to formula. [ABSTRACT FROM AUTHOR]

Background: Human milk bank is a sustainable source of donor human milk (DHM) which is an acceptable alternative to the mother's milk and it is not routinely available in Nigeria, a multi-ethnically diverse country.The study aimed to assess the willingness to donate or accept human milk among pregnant women and mothers attending the antenatal, immunization, outpatient, under-five, and neonatal follow-up clinics in selected health facilities in Ekiti State, Southwest Nigeria., Study Design and Methods: A descriptive cross-sectional, mixed methods study design was used to collect data in selected health facilities in Ekiti State. Questionnaires and focus group discussions were used to collect quantitative and qualitative data respectively while data analysis was done using the IBM® Statistical Package for Social Science SPSS version 26® and thematic analysis respectively., Results: Of the 798 respondents, 529 (66.3%) and 626 (78.4%) did not know about wet nursing or human milk banking (HMB) respectively and 139 (17.4%) were willing to donate their breastmilk for a stipend. In the focus group discussion, 50% had heard about wet nursing but none heard about HMB. Maternal educational level had a significant impact on their willingness to donate or accept DHM ( p  < 0.00). Wholesomeness, cultural, and religious biases were major reasons affecting HMB acceptability., Conclusions: Awareness and perception of HMB are poor. Appropriate information, education, and counselling on HMB are needed to drive the adoption and establishment of HMB in Nigeria., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Although political and academic interest exists in Ghana to include human milk banks (HMB) into current maternal and child health programs, efforts to establish a HMB have not yet been subjected to any real empirical inspection with the view toward implementation. Furthermore, views toward the establishment of a HMB in Ghana have not been assessed among Ghanaian women. The aims of the current study were to examine Ghanaian women's views about HMB, and to investigate women's willingness to donate to a HMB., Methods: Quantitative and qualitative responses were received from Ghanaian females ( n = 1,270) aged 18+ years. Excluding outliers and missing data ( n = 321), a final sample of 949 was retained for final analysis. Chi-square tests and logistic regression analysis were computed on quantitative data; Thematic analysis was performed on the qualitative responses., Results: In our sample, 64.7% of respondents indicated that Ghana is ready for a HMB. The majority (77.2%) were willing to donate milk, and 69.4% believed that donating to the HMB would favor their child. The main concerns for the unwillingness to donate excess milk included: (i) the idea of HMBs as strange/bizarre ( n = 47), (ii) fear of infections ( n = 15), (iii) religious beliefs ( n = 9), and (iv) insufficient information ( n = 24). This study serves as the first step toward the development of a HMB in Ghana., Conclusions: Overall, Ghanaian women support the building of a HMB to enhance infant nutrition and reduce childhood morbidity and mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Obeng, Jackson, Amissah-Essel, Nsiah-Asamoah, Perry, Gonzalez Casanova and Obeng-Gyasi.)

Mother’s own milk (MOM) is the first choice in preterm infant feeding, and when it is not available or is insufficient, donor human milk (DHM) is recommended. It has been shown that feeding preterm infants with human milk is less related to major morbidities, enhances feeding tolerance and prevents metabolic syndrome in childhood. As The Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) states, specific guidelines for Human Milk Banks (HMB) are needed to guarantee the best possible compromise between microbiological safety and nutritional/biological quality of human milk (HM). Currently, Holder pasteurization (HoP: pasteurization process at 62.5-63°C for 30 minutes) is recommended by all international guidelines: this method inactivates bacterial and viral pathogens but it also affects some nutritional and biological properties of human milk. New methods to ameliorate the biological quality and safety of DHM are under investigation in the last years. High Pressure Processing (HPP) is a non- thermal process used in food industries: this technology inactivates pathogenic microorganisms by applying hydrostatic high pressure, however further researches are required before applying this technology in milk banking. Ultraviolet-C irradiation (UV-C) is another non-thermal method capable of reducing vegetative bacteria in human milk and it also seems to preserve higher levels of immunological proteins than HoP. High-temperature short-time pasteurization (HTST: flash pasteurization, 72°C for 5-15 seconds) currently is available only at industrial level, but it could represent an alternative to HoP seeming to maintain the protein profile and some of the key active components of DHM. Further researches are needed to define the optimal treatment of DHM. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy) · October 26th-31st, 2015 · From the womb to the adult Guest Editors: Vassilios Fanos (Cagliari, Italy), Michele Mussap (Genoa, Italy), Antonio Del Vecchio (Bari, Italy), Bo Sun (Shanghai, China), Dorret I. Boomsma (Amsterdam, the Netherlands), Gavino Faa (Cagliari, Italy), Antonio Giordano (Philadelphia, USA)

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. [ABSTRACT FROM AUTHOR]

Justification: Shaping up the post-2015 development agenda is of crucial importance in the development process around the Globe as 2015 was the last year of milllionium development goals. It is the right time to asses our own progress vis-a-vis the Millennium Development Goals and these Guidelines are an attempt in that regard. Process: The Infant and Young Child Feeding (IYCF) chapter of Indian Academy of Pediatrics invited a group of experts for National Consultative Meet for discussing and contributing on latest scientific advances and developments. Various partners from WHO, UNICEF, Ministry of Child Welfare Department, Ministry of Health and Family Welfare, Ministry of Chemical and Fertilizers of Govt of India, Human Milk Banking Association (of India), Indian Medico-Legal and Ethics Association (IMLEA), non-governmental organizations and academicians from various states of India contributed to these guidelines. The guidelines were finalized during the IYCNCON 2015 at New Delhi in August 2015. Objectives: To formulate, endorse, adopt and disseminate guidelines related to Infant and Young Child feeding from an Indian perspective (including human milk banking, infant feeding in the HIV situation, and micro-nutrients). Recommendations: Early initiation of breastfeeding within first hour of birth, exclusive breastfeeding for the first six months followed by continued breastfeeding for up to two years and beyond with appropriate complementary foods after completion of 6 months is the most appropriate feeding strategy. Micro-nutrient supplementation in infants, and adequate nutrition and anemia control for adolescent girls, pregnant and lactating mothers is advocated. Concepts and need for human milk banks in India has also been incorporated. [ABSTRACT FROM AUTHOR]

When mothers of preterm infants are unable to produce sufficient volumes of breastmilk, neonatologists in many Western countries prescribe pasteurized donor breastmilk. Breastmilk has a paradoxical presence in the neonatal intensive care unit: while it has therapeutic properties, it also has the potential to transmit disease. National health authorities and local neonatal intensive care unit policies each delimit the safety of donor milk by focusing on the presence or absence of pathogens. It is in this light that breastmilk from the human milk bank is both sought and legitimated to minimize safety concerns. This research uses data arising from an ethnographic study of two human milk banks and two neonatal intensive care units in the United States, and 73 interviews with milk donors, neonatal intensive care unit parents and clinicians. The primary research question framing the study was ‘What are the underlying processes and practices that have enabled donor milk to be endorsed as a safe and legitimate feeding option in neonatal intensive care units?’ This study is framed using three key principles of Latour’s ‘new critique’, namely, adding to reality rather than debunking it, getting closer to data rather than turning away from fact and creating arenas in which to assemble. As a result, conceptions of donor milk’s safety are expanded. This case study of donor milk demonstrates how Latour’s new critique can inform science and technology studies approaches to the study of safety in health care. [ABSTRACT FROM PUBLISHER]

Justification: WHO and UNICEF state that the use of human milk from other sources should be the first alternative when it is not possible for the mother to breastfeed. Human milk banks should be made available in appropriate situations. The IYCF Chapter is actively concerned about the compelling use of formula feeds in the infants because of the non availability of human breast milk banks. Process: A National Consultative Meet for framing guidelines was summoned by the IYCF Chapter and the Ministry of Health and Family Welfare, Government of India on 30th June, 2013, with representations from various stakeholders. The guidelines were drafted after an extensive literature review and discussions. Though these guidelines are based on the experiences and guidelines from other countries, changes have been made to suit the Indian setup, culture and needs, without compromising scientific evidence. Objectives: To ensure quality of donated breast milk as a safe end product. Recommendations: Human Milk Banking Association should be constituted, and human milk banks should be established across the country. National coordination mechanism should be developed with a secretariat and technical support to follow-up on action in States. Budgetary provisions should be made available for the activities. [ABSTRACT FROM AUTHOR]

Aims: Several studies have recently reported the detection of oncogenic human papillomaviruses (HPV) in human milk of a minority of lactating mothers. These findings raised safety concerns in the context of human donor milk banking given the potential risk of HPV transmission to recipient infants. The aim of this study was to investigate whether the Holder pasteurization, a procedure currently in use in human donor milk banks for milk pasteurization, completely inactivates high-risk and low-risk HPV. Methods: HPV pseudoviruses (PsV) were generated, spiked into cell culture medium or donor human milk and subjected to thermal inactivation. HPV PsV infectivity and morphological integrity was analyzed by cell-based assay and by electron microscopy, respectively. Results: The Holder pasteurization completely inactivated the infectivity of high-risk (types 16 and 18) and low-risk (type 6) HPV both in cell culture medium and in human milk causing PsV particle disassembly. Conclusions: The results presented here indicate that the Holder pasteurization is an efficient procedure to inactivate high-risk and low-risk HPV thus preventing the potential risk of their transmission through human donor milk. [ABSTRACT FROM AUTHOR]

There is an increased use of pasteurised donor human milk (PDHM) in North American neonatal intensive care units (NICU) in order to achieve exclusive human milk (EHM) feeding for preterm infants. Australia, on the other hand, is relatively new to reintroducing PDHM to NICUs. Very little is known about the perception of multidisciplinary NICU teams toward PDHM. This article reports on a survey of 89 NICU clinicians that was implemented during the first weeks of PDHM use in an American NICU, and was repeated 6 months later. Their knowledge and opinions of PDHM in addition to their inclination to recommend its use were evaluated using thematic coding and descriptive statistics. We found that after a 6-month trial, preparedness to recommend PDHM increased to 93%. We found that NICU clinicians' support for PDHM exceeded their knowledge about its risks and benefits and clinicians requested education about various aspects of PDHM. This research in this article aims to assist clinical staff educators as they go about introducing PDHM in NICUs. [ABSTRACT FROM AUTHOR]