Batting for human milk banks

Neeta Lal

It is acknowledged that mother’s milk can be a life saver for infants especially in countries like India where infant mortality rate is still alarming. Human milk banks, therefore, assume greater importance for the number of mothers who are too feeble to breast feed is large. This is all the more desirable as it has now been discovered that babies that are breast fed are comparatively more intelligent. 
 

In India, where infant mortality rates are among the world's worst - 57 deaths per 1,000 live births - and infant deaths in the newborn's first month is a disquieting 43 per 1,000, preventive medical measures can go a long way in saving lives.

It was towards this aim that Asia's first human milk bank was set up at the Lokmanya Tilak Municipal General Hospital (LTMGH) in Mumbai in 1989. Since then, some 25 human milk banks across India - most of them sited in the western states of Maharashtra and Gujarat - have been performing vital services for premature babies requiring temporary intervention in cases of delayed lactation, abandonment or illness. These banks have also been lifesavers for infants whose undernourished mothers may be too feeble to breast feed.

"As incidents of low birth weight and pre-term babies are very high in India, it is imperative for the survival of these babies that constant and adequate supply of milk is guaranteed to them. Milk banks can perform a critical function in such a scenario," says Dr Priti Vyas, a senior obstetrician at Fortis Hospital, New Delhi.

Non-lactation, according to the doctor, can be triggered by stress during pregnancy or during delivery. It can also be caused by consumption of alcohol or smoking, postpartum hemorrhaging or premature birth.

In such cases, experts believe giving human milk to a pre-term baby on a ventilator can not only help save its life but also hold off life-threatening ailments like asthma, diabetes, infections and allergies. Such milk may also be used to treat many conditions in Neonatal Intensive Care Units like prematurity, malabsorption, short-gut syndrome, intractable diarrhea, congenital anomalies, formula intolerance and immune deficiencies.

Global studies have demonstrated that breast milk is far superior to mass-produced formula milk. In fact, there have been specific studies to illustrate that formula-fed infants have a significantly lower IQ scores than those weaned on breast milk. The World Health Organization and the United Nations Children's Fund, made a joint statement in 1980 advising that "Where it's not possible for the biological mother to breast feed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in such situations."

In New Zealand, research that followed the growth trajectory of more than 1,000 children from birth until age 18, demonstrated that children who were breastfed performed better in school and scored higher on standardized math and reading tests. The research's authors - David M Fergusson and L John Horwood of Christchurch School of Medicine - underscored that omega 3 fatty acids (or DHA) which are present in breast milk (but not in formula milk) promote lasting brain development. The authors discovered that the longer infants were breastfed, the higher they scored in evaluations.

According to Dr Armida Fernandez, founder of India's first human milk bank at LTMGH, human milk banks are crucial for India because even though the practice of women donating milk on humanitarian grounds is common, it is erratic and the shelf life of such milk is not more than 24 hours. What is required in such circumstances, is a reliable institution like a milk bank which can "pool, preserve and provide milk for nearly six months".

Human milk provides factors not replicated in any other source of nutrition, according to Fernandez. It is also the best nutrient for an infant and the provision of a safe source of donor milk supports breastfeeding by accentuating that human milk cannot be replaced. The milk bank is thus an advanced form of wet nursing practiced in the countryside.

The milk bank at LTMGH feeds over 30 sick and premature babies each day. The milk collected comers from lactating mothers who come to the hospital and in some cases even from outsiders. After extraction, the milk is cooled and poured into autoclave stainless steel containers measuring 150cc, 250cc or 300cc. It is then pasteurized at 65 degrees Celsius for 30 minutes and then frozen at minus 20 degrees Celsius. This way, it can be stored for up to six months.

Random culture is also conducted during which 2 cc of the pasteurized milk is sent for microbiological testing at the lab for HIV, history of jaundice and syphilis. It is also subjected to tests to detect "milk culture" or its biochemical status. Babies weighing less than a kilogram are fed about two cc of milk every two hours.

The milk extracted at banks may be of three kinds. The colustrum extracted in the first four days from a woman is given to babies infected with diarrhea and malnutrition or those suffering from burn injuries. The milk collected over the next five to ten days is "transitional milk" and the milk collected thereafter is called "mature milk" which has less protein. The quantity, drawn with the help of a pump, ranges from 40 to 600 cc per mother. However, as pediatricians point out, such milk can only be a stopgap arrangement for sick, pre-term or undernourished babies.

Despite the vital service milk banks are providing in India, their number hasn't seen a steep rise. Nor is the government doing much to promote setting up of new milk banks in the future. As a result, it's a rare investor who is keen to pump money in such ventures.

It's a quintessential Catch-22 situation: because the number of human milk banks in India isn't too large, they have not yet been accorded "industry" status. This naturally excludes them from benefits awarded to the organized sector. Small wonder then that there is no uniform standard for quality control, a template for starting a breast milk bank, a protocol for donor screening, collection techniques, transportation and storage.

According to Dr Sandhya Khadse of Sasoon General Hospital in Pune, there is an urgent need to create more awareness about milk banks and motivate people to support such ventures. Khadse recently inaugurated a milk bank at Sasoon Hospital in Pune (a city with about 9,000 births annually) and feels that there is a need to promote breastfeeding amongst the masses. At Sasoon, for instance, the doctor has displayed charts to inform mothers about the importance of breast milk and breastfeeding hygiene. She is also motivating women to save their extra milk for other needy babies.

Similarly, at LTMGH, lactation nurses spread awareness about the bank by informing lactating mothers admitted to the hospital about the milk bank and also handle their queries related to milk donation.

Like India, the global system of human milk banking has seen slow progress. While it was a popular concept in the West during the 1960s, things began to sour with the arrival of infant formula milk. Further, a fear of transmission of viruses such as HIV in body fluids led to anxiety about the donation of body fluids, including breast milk, and inhibited the momentum of the milk bank movement.

Despite such hurdles, there's no denying that human milk banks have a vital function to perform in society. According to the UN, the Millennium Development Goal For Child Survival by 2015 can't be achieved without a significant plummet in neo-natal deaths which account for 30% of the deaths of the world's under-five children. The neo-natal mortality rate, estimated at 4 million annually, has its largest share in south Asian countries - especially India, Pakistan, China and Bangladesh - according to the International Society of Tropical Pediatrics (ISTP).

The ISTP, which recently met in India, called for the adoption of new measures to strengthen safe motherhood and child survival services and the imperative need to institutionalize links at various levels to fill up gaps in the provision of health care. Effective and low-cost interventions, according to the ISTP, are urgently needed in this sector.

In such a scenario, establishing more human milk banks can be crucial in saving young children's lives.