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The roles of the breast milk bank

Publisher/Author : Pacific Cross
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Authors:
1. Le Van Nhan MD., PhD., Director of Medical Services Department, Pacific Cross Vietnam, Lecturer of Pham Ngoc Thach University of Medicine
2. Tran Vinh Tai MD., MHEM, Lecturer of Pham Ngoc Thach University of Medicine
© 2019 Pacific Cross Vietnam All Rights Reserved

Breast milk is a valuable source of nutrition for babies and young children. For premature infants, low birth weight babies or gastrointestinal diseases, breast milk is even more important, which is vital. However, these children benefit from long-term isolation treatment in intensive care units and most are not breastfed as most mothers are unable to give breast milk several times a day to their babies. Formula can be nutritionally safe for children, but some children cannot digest formula and increase the risk of necrotizing enterocolitis. Given breast milk is the most appropriate source of breast-milk substitutes. However, the donor’s breast milk poses a high risk of infection with infectious diseases such as HIV, hepatitis B, hepatitis C, HTLV (human T cell virus), CMV (cytomegalo virus) ) and syphilis. It should be mentioned that these diseases are sexually transmitted and asymptomatic when newly infected. Women who give milk can get sick without knowing it and do not know that they are at risk from friends. In addition, if the milking is not aseptic, the milk containers are not clean, poorly stored, the milk will be contaminated, which can cause gastrointestinal infections in children. The naked eye cannot know which milk is contaminated, but must use specialized tests. The American Institute of Pediatrics has stated that “the quality control of pasteurized donor milk is extremely important and needs to be monitored.” The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) recommended that the given infant formula be provided by an established breast milk bank, in accordance with specific safety guidelines. According to Tu Du hospital statistics in Ho Chi Minh City, there are currently between 6,000 and 7,000 cases of premature babies with low birth weight in hospitals, more than half of whom weigh less than 1,000 g and more than 70% of them are at high risk of necrotizing enterocolitis and death.

If all these infants received pasteurized breast milk, the baby’s survival rate increased significantly, reducing the length of stay in hospital and the rate of neonatal infections. That’s the reason why the idea of a breast milk bank was born because the breast milk bank is a bridge between donor mothers who want to give their milk and bring the milk lines that are safe and invaluable for the statue needs breast milk: babies born with less than 1500 grams of premature babies, very sick babies with intensive resuscitation, premature babies unable to receive breast milk because of serious maternal illness and who take the drug affects breast milk, or the distant mother has no conditions to send milk to her child.
The world’s first breast milk bank (BMB) was founded in 1909 in Vienna, Austria. There are currently more than 600 BMB in the world (over 37 countries). In Asia, BMB is present in many countries such as India, the Philippines, Malaysia, Taiwan, Myanmar, Korea, Singapore and China. In Vietnam, the first BMB was created at the Da Nang Obstetrics and Children’s Hospital on February 18, 2017.
In Ho Chi Minh City, on April 10, 2019, Tu Du Hospital in Ho Chi Minh City also launched BMB. This BMB is considered the 2nd BMB, open for the following purposes: to help increase the rate of breastfed children, on this basis, to help reduce child mortality and morbidity rates at Tu Du Hospital; contribute to the promotion of the breastfeeding program not only at the hospital but also through Ho Chi Minh City through communication strategies and a network of volunteers; create an influential model not only in the country but also in South-East Asia and contribute to the development of guidelines for the establishment and operation of mother’s milk banks at national level.
The main objectives that BMB of Tu Du Hospital must implement:

  1. Provide 100% sterilized given breast milk (SGBM) for premature newborns treated at Tu Du hospital without intestinal breast milk.
  2. Provide 100% SGBM for pathological newborns treated at Tu Du hospital without breast milk.
  3. Provide 100% SGBM for pathological neonates treated at Tu Du hospital without breast milk and healthy babies during the first three days after birth without enough breast milk.
The advantages of the SGBM: the use of the SGBM decreased the risk of necrotizing enterocolitis by 3 times compared with formula; SGBM reduced the risk of late neonatal infection by 19% in vulnerable infants with low birth weight in the first 28 days of life compared with infant formula; SGBM reduce the duration of hospitalization by 15 days and the duration of vein maintenance up to 10 days compared to the formula; Exclusive breastfeeding rate increased by 10% in intensive care units for newborns with BMB; preterm infants fed SGBM have better tolerance, less vomiting, less engorgement and less diarrhea compared to infants fed formula.

The process of donated breast milk safely is not easy. First, the screening of volunteer mothers who donate milk have the right to donate milk. Mothers who need to be screened for the above-mentioned infectious diseases, should have confirmation that their behavior is safe, such as smoking, drinking alcohol, taking medicines that affect breast milk and receiving blood, tattooing… After that, mothers need to know how to express milk to ensure sterility. The donated milk is tested before and after it is put into a pasteurizer (heated at high temperature). Pasteurization will help kill some pathogenic bacteria but at the same time reduce antibodies, lose fat and yeast. If the milk sample is negative for both bacterial cultures, the milk can be transferred to a freezer for use. If necessary, the frozen milk will be thawed slowly by machine for 24 hours to reach the required temperature 40oC. Thawed milk will be transported properly to the place where it will be used.
BMB is a service designed to select and filter mothers who donate milk, collect donated milk, treat, filter, store and distribute it to meet their specific birth needs for optimal health./.
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References:

  1. Website of World Health Organization: https://www.who.int/
  2. Website of Tu Du hospital in Ho Chi Minh city: https://www.tudu.com.vn
  3. Expert documents: Arslanoglu, Corpeleijn et al. in 2013; Arslanoglu, Corpeleijn et al. in 2013; Quigley, McGuire et al. in 2014; Kantorowska, Wei et al. in 2016; Halleux, Pieltain et al. in 2017
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