NDIAN P EDIATRICS V OLUME UNE reastfeeding is the - PDF document

469V 51 15, 2014the only milk which is tailor-made anduniquely suited to the human infant. Allinfants. When a mother, for some reason, is unable tofeed her infant directly, her breastmilk should beexpressed and fed to the infant. If mother’s own milk isunavailable or insufficient, the next best option is to use WHO and UNICEF state that the use of human milk from other sources should be the first alternative when it is notpossible for the mother to breastfeed. Human milk banks should be made available in appropriate situations. The IYCF Chapter is actively GGGGGUUUUUIIIIIDDDDDEEEEELLLLLIIIIINNNNNEEEEESSSSS 470V 51 15, 2014HARADVAthe purpose as donors are likely to be found in largenumbers where medical and nursing staffs can encourageorganizations (NGOs) taking care of abandoned babiescan also have a human milk bank in their facility.gut syndrome, sepsis, and post-surgical gut healing inexclusive diets of preterm formula human milk,nutrition and higher rate of surgical necrotizingenterocolitis (NEC) in infants receiving preterm formulaformula(by early enteral feeds) exclusively with human milk inVLBW infants with banked human milk [5].If PDHM supplies are sufficient donor milk may be•Absent or insufficient lactation: Mothers withbreastmilk for their neonates initially.•For babies of non-lactating mothers, who adopt•Abandoned neonates and sick neonates.•Temporary interruption of breastfeeding.•Infant at health risk from breastmilk of the biologicalmother.•Babies whose mother died in the immediatefor creation of human milk banks. The minimuma crèche helps in reducing stress of donors. Teachingvideos of Kangaroo Mother Care (KMC), expression ofshown under supervision of milk bank staff.Pasteurizer/Shaker-water bath: its use. A conventional pasteurizer is expensive andgenerally of dairy-industry size and is often not suitablebank. A well accepted alternative is the use of a shakertemperature regulator, an electronic timer device and ashaker speed controller. The milk in the container isshaker bath. To avoid coagulation of the milk and todistribute heat evenly, the tray on which the milkcontainers are placed is shaken / wobbled. This shakerto 400 mL capacity.flash heat treatment, HTST (High Temperature ShortTime; 72°C for 16 seconds) and ultra violet irradiation°C for 16 seconds) and ultra violet irradiationDeep freezer: A deep freezer to store the milk at -20with an alarm setting. It is desirable to have two deepavailable. This freezer should be locked at all times withwhole day’s collection is over and the milk is ready to berequired for thawing the milk before being dispatched.Preferably two different units should be used for theseshould be kept in one unit for each purpose.A hot air oven / autoclave in the 471V 51 15, 2014HARADVAfrom donors, containers for pasteurization and the testmicrobiology laboratory.Breastmilk pumps:and comfortable to use. There is no major difference inference inoperated breastmilk pumps designed to operate morephysiologically by simulating the infant’s compressivewith lower cost implications [9]. They can be reused withThey can be reused withcleaned properly [11]. Pump and its parts should besterilized/disinfected as per manufacturer’s instructions.propylene are used across the world. However, in Indianscrewed caps are equally effective. They are easilyon storage; however, cellular components are reduced., cellular components are reduced.Generator/Uninterrupted power supply: Every milkbank should have a dedicated centralized source ofuninterrupted power supply backup to run the deepfreezers and refrigerators in case of electricity failure.Milk analyzer: It is desirable to have macronutrientfat of a milk sample, using infra-red spectroscopytechnology, in teaching hospitals as a step towards lacto-representatives from the areas of pediatrics/neonatology,lactation, microbiology, nutrition, public health and foodtechnology. It should consist of a Director (for planning,officer (usually a doctor, for day-to- day running of the TAFF•Standard operating procedures (SOP) of the bank (which•Hygienic practices like proper hand wash, donning gowns,•Gloves should be worn and changed between handling raw•Staff should undergo regular health checks and be•There should be a program for ongoing training of thestaff.General guidelines for staff are outlined in OPULATIONwilling to donate their milk, or lactating working staff inthe hospital, and motivated mothers from the community.Try to reach maximum donor population usingmilk donors [11] are outlined in Box 2.collection center. Breastmilk is collected by trained staffexpression is chosen by the donor. Home collection ofof the risk of contamination. Washing the breast with 472V 51 15, 2014HARADVAdisinfectant [14]. There is no rationale in discardingThere is no rationale in discardingnot recommended for banking.The breastmilk may be expressed manually (handexpression) or with breast pumps. Manual expression isa low cost and effective method of expression, andassociated with less risk of contamination. Simultaneousefficacious than sequential breast expression [16]. MilkProcessinghydrolysis of triglycerides [17]. While mixing fresh rawfrom same donor, it should be chilled before adding to, it should be chilled before adding toadvisable to use a new container for each pumping.Before pasteurization, pooling and mixing may becarried out from multiple donors to ease the process ofprocessing and storage. Pasteurization is carried out byHolder’s method.Microbiological screening of donor milk is doneMicrobiological screening of donor milk is doneendotoxins of organisms are still present in the milk inclinical effect on the baby. A bacterial count of 10S. aureusS. aureus as threshold values, as threshold values,in post-pasteurization microbiology cultures. Wholebatch of culture positive container of pasteurized milkStoragedisburse it till the culture is negative. Storage should bePDHM should be disbursed at physician’s requisition 2: •is in good health, good health-related behavior, and not•is willing to undergo blood testing for screening of•has enough milk after feeding her baby satisfactorily andbaby is thriving nicely.•uses illegal drugs, tobacco products or nicotine•regularly takes more than two ounces of alcohol or itsequivalent or three caffeinated drinks per day; or•has a positive blood test result for HIV, HTLV, Hepatitis B•is herself or has a sexual partner suffering from HBV, HIV,•has received organ or tissue transplant, any blood•is taking radioactive or other drugs or has chemicalthe neonate and excreted in breastmilk; or•has mastitis or fungal infection of the nipple or areola, 473V 51 15, 2014HARADVAFirst-in-first-out basis from the storage. Transport ofransport ofresults in reduction in the IgA content of the milk andthere is a risk of burns if the milk is used too soon [18].Milk should not be refrozen after being thawed as thisincreases the hydrolysis of the triglycerides in the milk.While bringing to room temperature, it should be gentlyagitated to make a homogenous mixture before use andshould be used preferably within 3 hours to preventcontamination.Labeling and record keepingconditions. Written standard operating proceduresdonation, pooling vessel and pasteurization container toform, donor’s and her child’s data, screening reports,consent form. Though rarely required, complications canIMPLICATIONSCost effectiveness of using banked human milk inWestern countries, largely due to reduction in the rate ofgely due to reduction in the rate ofmilk bank with potential cost-saving due to reduction inNEC, sepsis and duration of hospital stay have not beenevaluated. Given the high incidence of sepsis and a largerate of preterm births in the country and level ofbabies after birth, there is an urgent need to establishmilk banks across the country, especially in the largeneonatal units of all hospitals. This document aims atcountry. This document is the abridged version of detailedguidelines. The detailed guidelines are available withwww.iycfchapteriap.org RK Agarwal,Ketan Bharadva, Satish Tiwari, CR Banapurmath, Balraj SinghYadav, Sudhir Mishra, Jayashree Mondkar, Poonam Singh,Sandhya Khadse, Kanya Mukhopadhyay, Sailesh GuptaCommissioner-Child Health, MoHFW), Karan Veer Singh(UNICEF), Arun Singh (NIPPI), Manoj Patki (PHFI), Deepti(PHFI), Ashfaq Ahmed Bhatt (Senior Health Advisor Norway),Lysandar Menezes (PATH), S Aneja, Geeta Gathwala, KundanMittal, Vishesh Kumar, Swati Patki, Sarath Gopalan,Meenakshi, Vinita Yadav, Sushila Yadav, CP Bansal, PresidentSupreme Court), Vijay Yewale, President IAP 2014 (could notWriting Committee: Ajay Khera, Ketan Bharadva, SudhirMishra, Jayashree Mondkar, Poonam Singh, Sandhya Khadse,Satish Tiwari, Balraj Singh Yadav, Vishesh Kumar, KanyaMukhopadhyay, CR Banapurmath, Sanjay Wazir, SaileshMinistry of Health-Family WelfareGovernment of India, Health and Medical Education Minister,Haryana Shri Rao Narender Singh, WHO, UNICEF, PHFI,PATH, NIPPI, Human Milk Banks and NGOs. We thank Dr.Rakesh Kumar (Joint Secretary-MoHFW), Dr. Ajay KheraDeputy Commissioner (Child Health and Immunization)MoHFW, Dr. Sila Deb (Deputy Commissioner - Child Health,organizing this National Meet. Dr Vinay Kulkarni for hisefforts in reference drafting.Smt Santra Devi Health and Educational Trust;Competing interest: None.1.Das BK, Mishra RN, Mishra OP, Bhargava V, Prakash A. 474V 51 15, 2014HARADVA2.Bharati P, Pal M, Bandyopadhyay M, Bhakta A,3.Arslanoglu S, Moro GE, Bellu R, Turoli D, De NG,4.Cristofalo EA, Schanler RJ, Blanco CL, Sullivan S,5.De NG, Berti M, De NM, Bertino E. Early enteral feeding6.Israel-Ballard K, Donovan R, Chantry C, Coutsoudis A,7.Terpstra FG. Antimicrobial and antiviral effect of high-8.Burton P, Kennedy K, Ahluwalia JS, Nicholl R, Lucas A,9.Fewtrell MS, Lucas P, Collier S, Singhal A, Ahluwalia JS,10.Gransden WR, Webster M, French GL, Phillips I. An transmitted by11.Breast Pumps. US FDA, Heal. Cent. Devices Radiol.ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/BreastPumps/ucm12.Janjindamai W, Thatrimontrichai A, Maneenil G,13.National Institute for Health and Care Excellence. Donor. Accessed October 17,14.N, Pickler RH, Munro C, Shotwell J. Contamination in15.Arnold LD. A brief look at drip milk and its relation to16.Prime DK, Garbin CP, Hartmann PE, Kent JC.17.Morera PS, Castellote Bargallo AI, Lopez Sabater MC.18.CDC. Proper Handling and Storage of Human Milk. Accessed October 17, 2013.19.Simmer K, Hartmann B. The known and unknowns of20.Hartmann BT, Pang WW, Keil AD, Hartmann PE,21.ABM Clinical Protocol #8: Human Milk Storage for home22.Arnold LD. The cost-effectiveness of using banked donor