Increasing the Use of Human Donor Milk : A Public Health Imperative

1. Increasing the Use of Human Donor Milk: A Public Health Imperative http://www.cafepress.com/thelactivist

2. Dixie Whetsell, MS, IBCLCBoard Member

3. Why are Donor Milk Banks Needed? • Human milk provides optimal nutrition, promotes growth & development, & reduces the risk of illness and disease. • Some mothers are unable to provide all the breastmilk their infants need. • In the absence of mother’s own milk, donor milk is the best substitute

4. Why use donor milk? • Human milk also contains growth factors that can: • protect immature tissue • promote maturation, particularly in the gastrointestinal tract • promote healing of tissue damaged by infection.

5. Human milk-fed premature infants receive significant benefits with respect to host protection and improved developmental outcomes compared with formula-fed premature infants. American Academy of Pediatrics 2005 Breastfeeding and the Use of Human Milk American Academy of Pediatrics, Breastfeeding and the Use of Human Milk 2005 Courtesy Kingproductions.com

6. Michelle Obama’s “Let’s Move” Obesity Prevention Campaign

7. Oregon Health Insurers Partnering for Prevention (OHIPP)

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9. Who needs donor milk? • Donor milk must be prescribed by a health care provider. • Common reasons for prescribing donor milk include: • Prematurity • Allergies • Feeding/formula intolerance • Immunologic deficiencies • Post-operative nutrition • Infectious diseases • Inborn errors of metabolism

10. US Surgeon General’s 2011 Call to Action to Support Breastfeeding • Call to Action – #12 • Identify and address obstacles to greater availability of safe banked donor milk for fragile infants

11. Necrotizing Enterocolitis (NEC) • Frequent and lethal disease affecting the GI tract of premature infants • Average mortality is 30-40% • Incidence among formula-fed infants in NICU 12-15% • Incidence among breastmilk fed infants in NICU 1.5%

12. Call to Action Report • About 12% of preterm infants weighing <1,500gms will suffer from NEC. • Hospitalization for a surgical case of NEC costs about $300,000 per patient. • NEC treatment accounts for 19% of all initial newborn health care costs in the US. • Human milk, including donor milk can reduce the burden NEC places on families and health care institutions.

13. What is a donor milk bank? • A service established for the purpose of screening, collecting, processing, and distributing human milk to meet the specific medical needs of individuals for whom it is prescribed.

14. History of Milk Banking • Roots of donor milk banking came from wet nursing. • 1909 - first European milk bank was established in Vienna • 1919 - first US milk bank was established in Boston • 1980’s, the increasing awareness of AIDS resulted in the closure of many milk banks in the US. • 1985 - Human Milk Bank Association of North America was formed to set standards for North American milk banks. • 1990’s -The number of milk banks grew with evidence of safety, and research on the benefits of human milk. • 2000’s - Use of donor milk is expanding, and the number of milk banks in North America is growing.

15. HMBANA is a professional membership association that sets the standards and guidelines for donor milk banking in North American milk. • Member milk banks are nonprofit. They screen donors, process and distribute donated milk. www.hmbana.org

16. Who do milk banks serve? • Currently there are 11 HMBANA member milk banks providing human donor milk to the US and Canada. • In 2000 the banks dispensed a combined total of 409,077 ounces of milk; that rose to 745,329 ounces of milk 2005—a 45% increase. • In 2005, the HMBANA milk banks sent milk to hospitals in over 80 cities located in 29 states and 3 Canadian provinces.

17. Why Develop A Milk Bank in Portland?

18. 2007 US Breastfeeding Initiation Goal 75% - Dark Blue

19. Operating Milk Banks Austin, TX Ft Worth, TX Denver, CO San Jose, CA Raleigh, NC Iowa City, IA Indianapolis, IN Kalamazoo, MI Columbus, OH Newtonville, MA Vancouver, BC, Canada Developing Milk Banks -Portland OR -Orlando, FL -Jackson, MS -Kansas City, MO -Toronto ON Canada Donor Milk Banks in North America

21. Donor Screening/Selection • Potential milk donors must meet requirements like those for blood donors. They must be: • In good general health • Willing to undergo blood tests to confirm health status • Not on medications or herbal remedies

22. When donor milk is received it is Logged in Given a batch # Transferred to a holding freezer to wait for processing Frozen donor milk is brought in by donors by staff or volunteers who pick it up from depots, or delivered by express mail services Donor Milk is Received and Logged In

23. Donor Milk is Processed • Tech follows HMBANA guidelines to process milk • Milk is thawed • Milk is emptied into flasks and mixed repeatedly • Milk is poured into smaller containers

24. The milk will be held in a shaking water bath at 62.5 degrees C for 30 minutes. Then milk is plunged into an ice slurry to quickly cool the milk. Donor Milk is Pasteurized and Cooled

25. Testing is done before and after pasteurization Bacterial Testing and Milk Analysis • Donor milk is analyzed for nutritional composition • -Protein • -Carbohydrates • -Fats • -Calories

26. Donor Milk is Frozen and Stored

27. Orders are received Critically ill infants are given priority Frozen milk is boxed to fill orders Boxes are labeled and shipped overnight Donor Milk is Distributed to Recipients

28. In the NICU, drops of Janie’s milk, Alicia’s milk, and Sarah’s milk were fed to Nora and Alison who grew up and breastfed happily ever after

29. What is the charge for donor milk? • There is a cost for each step of screening, processing, and shipping milk. Donors are volunteers and do not get paid. • Non-profit milk banks charge $3.50 - $4.50 per oz for processing donor milk. • Health insurance will sometimes cover the processing fees. • Some health care institutions do not charge patients for the cost of donor milk processing and shipping. • The processing fees do not cover all operating costs. • All HMBANA donor milk banks depend upon donations from individuals, corporations, foundations and community groups to cover the true costs of processing and shipping donor milk.

30. Northwest Mothers Milk Bank Board -Non-profit established in 2008. -Recognized by HMBANA as a Developing milk bank -Not processing milk yet. -Board of Directors -Medical Advisory Council

31. Our first large fundraiser “Harvest” September 2010 Raised $30,000

32. Drop-Off Sites • A donor drop-off site works with a specific milk bank. Donors that have already been screened and accepted can drop milk off at that site to be shipped to that milk bank. Providence St. Vincent Medical Center

33. March 2011 Providence Health Donates office space for 3 years In SW Portland for Northwest Mothers Milk Bank

35. Frequently Asked Questions about Northwest Mothers Milk Bank? • How long will it take? 18-36 mths • How much money do we need? $400,000 to get started • How many staff members are needed? 3-5 • How many volunteers are needed? Lots!

36. What can I do to help create Northwest Mothers Milk Bank? • Make a financial donation$$$$ on our web site www.nwmmb.org • Attend a fundraising event and donate www.nwmmb.org • Volunteer – become a Board Member email: volunteers@nwmmb.org • Become a milk donor for another milk bank until one exists here • Use www.goodsearch.com to do internet searches and donate to Northwest Mothers Milk Bank every time you do an internet search. • Invite others to come with you to see our new office space and encourage them to get involved too. info@nwmmb.org

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