Resources for Health Care Professionals
The Milk Bank offers services that can help you meet the requirements for the Joint Commission Perinatal Core Measure mandated in January 2014 that addresses exclusive human milk feeding.
Since our establishment in 2005, The Milk Bank has been proud to be recognized as an active member of the Human Milk Banking Association of North America (HMBANA). The Milk Bank is a non-profit organization that promotes community health by providing pasteurized donor human milk (PDHM) for all babies, especially premature and ill infants. HMBANA guidelines provide evidence-based direction to support the screening, handling and distribution of a safe optimal product by its member banks.
Extensive research has shown the value of using PDHM in the Neonatal Intensive Care Unit (NICU) and hospital settings. According to the Academy of Breastfeeding Medicine (2017), PDHM is the next best option if mother’s own milk is unavailable. Additionally, the American Academy of Pediatrics (AAP) states: “If mother’s own milk is unavailable despite significant lactation support, PDHM from a milk bank should be used” (2012).
Studies have shown that the use of PDHM can reduce the need for total parenteral nutrition (TPN) resulting in significant cost savings. The use of PDHM for both premature and high risk infants has been shown to reduce the incidence of many conditions including necrotizing enterocolitis, sepsis, and infection, resulting in a shorter length of stay (HMBANA 2015). Overall, human milk results in both short and long term health care cost saving; therefore it makes economic sense to invest in the purchase of pasteurized donor human milk for your infants (HMBANA, 2015; Edwards & Spatz, 2012).
Please review the items listed below. When you are ready to partner with The Milk Bank and offer pasteurized donor human milk at your healthcare facility contact Sarah Long, IBCLC, Director of Clinical Operations, 317-536-1670, extension 104, or firstname.lastname@example.org.
5 FAQs about Pasteurized Donor Human Milk
How are milk donors screened?
Our donors are healthy, lactating mothers who are screened for medical and lifestyle histories, and receive blood tests for HIV 1 & 2, HTLV 1 & 2, Hepatitis B & C, and Syphilis.
The screening process meets the guidelines set forth by the Human Milk Banking Association of North America (HMBANA). These strict guidelines were developed in consultation with the FDA, CDC and the blood and tissue banking industries.
Is The Milk Bank accredited or inspected?
The Milk Bank adheres to the strict guidelines published by HMBANA (Guidelines for the Establishment and Operation of a Donor Human Milk Bank). These guidelines address three layers of recipient protection: extensive donor screening, milk pasteurization, and microbiology testing. They are a minimum standard for all member banks. The Milk Bank is evaluated for adherence to these guidelines by a member of the HMBANA accredidation team annually. The Milk Bank is 100% compliant and exceeds these guidelines in many areas.Is the milk pasteurized and cultured?
Yes. All pasteurized donor human milk is pasteurized using the Holder Method, a process of heating milk to 62.5 degrees Celsius for 30 minutes and then rapidly cooling it in an automatic pasteurizer. The pasteurization process kills bacteria, while preserving most of the immunologic properties unique to human milk. The macronutrients are unchanged by pasteurization.
A random sample is then selected from each batch of PDHM and sent to a laboratory for microbiology testing. Only milk that shows no growth is approved and available to dispense. All cultures are performed at a CLIA CAP accredited lab.
What steps are taken to insure the safety and security of the milk?
All PDHM is shipped to the hospital in new, clean, insulated containers using packing material to minimize the contamination of the outside of the bottles that will be at the bedside of vulnerable infants. Milk Bank staff packing the donor milk use a clean technique. Each container is packed with dry ice to ensure that the milk remains frozen. Each bottle cap is sealed with a tamper-proof seal. The NICU staff member receiving the shipping container should inspect the box to make sure the milk arrives completely frozen and the bottles’ tamper seals are in place.
How is donor milk packaged?
PDHM from The Milk Bank is packaged as follows:
- 17 Kcal/oz. and 20 Kcal/oz.
- Available in both 2 oz. and 4 oz. bottles
- 22+ Kcal/oz.
- Available in 2 oz. bottles only
The bottles are designed and tested specifically for the processing and distribution of donor human milk. They are made of high density polyethylene (HDPE) that is Bisphenal A (BPA) and phthalate free. The material is stable and will not leech into milk. These bottles are safe to warm and freeze milk in. There is a tamper evident seal under the lid. The bottles are labeled with the expiration date and batch number. The cost of this packaging, along with cost of The Milk Bank’s pasteurization process are considered when establishing the processing fee charged for PDHM.
Use Pasteurized Donor Human Milk in Your Hospital
The process of using PDHM in your facility is simple - and The Milk Bank staff can help.
Schedule an in-service at your facility. The Milk Bank staff is available for educational in-service sessions or presentations for hospital staff regarding the use of PDHM and our programs. The Milk Bank can also provide policy guidance and support for implementation of a PDHM program at your facility.
Contact The Milk Bank for ordering and distribution procedures. The Milk Bank disburses all orders by overnight UPS delivery. Orders placed before 2 pm EST Monday through Thursday will be delivered next day. Orders placed after 2 pm EST or on Friday will be shipped the following business day, unless the need is an emergency.
The Milk Bank distributes milk with a caloric content of 20Kcal/oz. Higher nutritional content, 22 Kcal/oz. and 24 Kcal/oz. PDHM may also be available in limited quantities, upon request.
Contact us today for more information on how you can provide PDHM to premature and ill infants in your facility.
Who Receives Pasteurized Donor Human Milk?
To ensure safe and effective use, PDHM is dispensed for clinical use by prescription or hospital purchase order only. The Milk Bank regularly supplies hospital neonatal intensive care unites (NICUs) with PDHM for use with premature or ill infants. PDHM can be prescribed for treatment of various medical conditions, including, but not limited to:
- Infants susceptible to or recovering from necrotizing enterocolitis (NEC)
- Failure to thrive
- Malabsorption syndromes
- Short-gut syndrome
- Trophic feeds/gut-priming
- Inborn errors of metabolism
- Pre- and post-operative nutrition
- Absent or insufficient lactation
- Illness requiring temporary interruption of breastfeeding
- Treatment for infectious diseases
- Immunodeficiency disorders
- Non-infectious intestinal disorders
Is Pasteurized Donor Human Milk Cost Effective?
Yes! Necrotizing entercolitis (NEC) is a leading cause of infant death impacting thousands of babies every year in the United States. The NICU cost burden of NEC among premature infants is huge. Not to mention the lifelong complications and medical costs that may follow a case of NEC.
Reasearch shows that an exclusive human milk diet offers these infants the most protection. The cost of using banked donor milk to feed premature infants is inconsequential when compared to the savings from NEC prevention. (Arnold, L. J Hum Lact: 18(2), 2002; 172-176.)
A reduction in length of stay, NEC, and sepsis may result in a relative savings of approximately $11 to the NICU or healthcare plan for each $1 spent for PDHM. (Wight, N.E. J Perinatol. 2001; 21:249-254.)
Ordering Pasteurized Donor Human Milk
After a purchasing agreement between The Milk Bank and your Healthcare facility is put into place you may order PDHM in any of the following ways:
- Email a purchase order to email@example.com
- Fax a purchase order to 317-536-1676
- Call The Milk Bank at 317-536-1670
PDHM from The Milk Bank is packaged as follows:
- 17 Kcal/oz/ and 20 Kcal/oz.
- Available in both 2 oz. and 4oz. bottles
- 22+ Kcal/oz.
- Available in 2 oz. bottles only
Each bottle is labeled with the pasteurization date, expiration date, batch number, calorie level and protein level. All bottles are sealed and checked for quality prior to pasteurization to ensure safety during processing and transportation.
Orders received prior to 2:30 p.m. EST will be delivered next day via UPS overnight delivery. Orders received after 2:30 pm EST will be shipped out the following business day. Orders are dispensed Monday through Thursday only. Orders can also be received same-day through a courier service for an additional fee.
Instructions for Using Pasteurized Donor Human Milk
- Before handling milk or feeding equipment:
- Actively lather hands with soap and water for 15 seconds, with special attention to the area around and under the finger nails
- Dry hands with a single-use towel
Storing Frozen Milk
- Store the milk in a freezer that always keeps ice cream hard
- Do not store in the door of a refrigerator or freezer because the temperature changes when the door is opened and shut
THAWING FROZEN MILK
- Thawing of milk must be gradual. Human milk must NOT be warmed to a a temperature warmer than body temperature. Never thaw frozen human milk in a microwave oven or hot water
- The prefered way to thaw frozen milk is to place it in the refrigeraator over a 48 hour period
- Milk may also be thawed as follows:
- Frozen milk can be thawed quickly in a container of warm water (not to exceed 98 degrees Fahrenheit). Take care that the water does not touch the lid
- Milk can thaw slowly at room temperature, but check often to make sure it is still chilled
- Once the milk is liquid, it may be maintained at room temperature for four hours and 48 hours in the regrigerator (32-39 degrees Fahrenheit)
TIPS FOR HANDLING PASTEURIZED DONOR HUMAN MILK
- Milk must be refrigerated after thawing
- Thawed milk should NOT be left at room temperature
- Once milk is thawed, it cannot be refrozen
WARMING FOR FEEDING
- Warm an individual feeding by standing the container of milk briefly in warm water or holding under warm water. Care must be taken to keep the cap dry.
- NEVER microwave human milk either to thaw or warm it
- Before feeding - SWIRL BUT DO NOT SHAKE the containter to ensure an equal districution of the nutrients
Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes and Child Care Settings (2005). Human Milk Banking Association of North America, p. 19.
Lactation After Loss
Dealing with the death of an infant is one of the most difficult situations in life. Each mother needs support to work through her grief in her own way. One aspect of neonatal loss that is often overlooked is lactation management and options for mothers including milk donation. For many mothers milk donation to a HMBANA milk bank has brought comfort during one of the most difficult times in their lives.
To provide an environment that facilitates optimal healing, healthcare professionals should be knowledgeable and comfortable addressing lactation after bereavement. In addition, they should be comfortable with the emotions that may pour forth as a result of discussing lactation with the breaved mother. An outpouring of emotions is a ahealthy response to the loss of a baby and it can facilitate healing especially when a bereaved mother is supported in the process. Often times, a bereaved mother appreciates the opportunity to talk about her baby because she has so few memories of her baby that died. It is one way of validating his or her short life and giving it meaning (Capitulo, 2004).
The most appropriate time to give a bereaved mother information about lactation is around the time that her baby passes away. Although this is a very sensitive time for a bereaved mother, it is also important to let her know that lactation is a reality and she will probably have to manage her milk in some capacity to prevent pain and discmfort from engorgement (Pugmire, 1999). Bereaved mothers work very closely with the nurses in the NICU while their baby is alive. For this reason, the NICU nurse is usally the first person to comfort a bereaved mother after her baby dies and to provide her with information and resouces. These resources should include information about lactation and information for a bereaved mother about how to manage her milk now that her baby has died. A lactation consultant could follow up with a bereaved mother from there to answer more specific questions and to provide additional information about donating milk or stopping milk production (Welborn, 2011).
A mother who experiences a death in-utero or a stillbirth may not be aware that her milk could increase in volume when she has no baby to feed. She may be in shock and traumatized to the point where milk production is the last thing on her mind. If she does not have any information about what to do when her milk volume increases, she could end up in severe pain from intense pressure in her breasts that results when milk accumulates in the breasts (Lauwer and Swisher, 2005). For this reason, a bereaved mother should be given information about the different options to hand milk production. It is best to give her this information right after her baby dies so that she knows what to do to maintain comfort when her milk volume increases.
The Milk Bank can provide in-depth Health Care Provider training on working with bereaved mothers. Additionaly, they can provide a sample hospital policy for addressing lactation with bereaved mothers. Contact The Milk Bank at 317-536-1670 for more information.
Lactation Support for the Breaved Mother: A Toolkit. Human Milk Banking Association of North America, p,1, 3, 4
Safety, Quality, and Analysis
In order to ensure the safety and quality of PDHM supplied to premature and ill infants, The Milk Bank adheres to strict guidelines and protocols developed by the Human Milk Bank Association of North American (HMBANA).
- A verbal and written medical history and lifestyle screening of potential donors is performed.
- Blood testing for HIV -1/2, HTLV-1/2, Hepatitis B & C, and syphilis is required for all donors and is repeated every six months if they are actively donating.
- Ongoing education is provided to our donors on the importance of notifying TMB if any new medications or illnesses arise. They receive information on the appropriate handling and storage of milk to be donated.
- In addition, TMB staff are required to communicate with approved donors frequently to ascertain any potential changes to their health, medical or lifestyle status.
- The Milk Bank staff must meet or exceed certain HMBANA specifications to be certified to pasteurize.
- Holder pasteurization eliminates viruses or bacteria that may be present in the milk.
- After pasteurization, a culture is sent to an independent laboratory to ensure sterility. The Milk Bank does not dispense any PDHM until the lab certifies it as sterile.
- Donor human milk from The Milk Bank is analyzed for Fat, Lactose, Protein and Solids, using the Delta LactoScope FTIR Advanced, this analyzer uses Fourier Transform Infra-Red Technology, which is calibrated for human milk, to evaluate macronutrient content. Working with the USDA, Federal Milk Market Administration, and Perten Instruments, the accuracy of the calibrations is maintained within the dairy standard of .02, with a repeatability factor of .006. Although no instruments for human milk analysis are currently FDA approved, we feel this additional step ensures that the milk that hospitals receive from The Milk Bank contains adequate calorie and protein content. While this does not replace monitoring infants for growth, it is an extra tool to insure optimum growth.
Since the establishment of HMBANA , there have been no cases reported of harm being done to a recipient due to the use of PDHM. For more information, please contact The Milk Bank.