Obstetrics

1. Human milk storage &
Banking
Dr Abbas
Associate Professor, Pediatrics
Career Institute of medical
sciences , Lucknow

2. Expression & storage of breast
milk
Expressing milk means squeezing milk out of
your breast so you can store it and feed it to your
baby late
Mannual Electronic

4. Storage of human milk
Why expressed breast milk?
working
mothers Sick
babies
Preterm/low birth weight
Congenital defects in babies (cleft palate)

5. Safe Storage of Expressed Breast
Milk
Safe expression:
• Wash your hands or , use an alcohol-based
hand sanitizer
• Mothers can express breast milk by hand or
with a manual or electric pump.
• Use clean pump.
• If using a shared pump kit, clean
with
disinfectant wipe.

6. Safe storage:
• Use breast milk storage bags or clean food-
grade containers
– Avoid bottles with the recycle symbol number 7.
• Never store breast milk in disposable bottle
liners or plastic bags.

8. • Clearly label the breast milk with the date
• Do not store breast milk in the door of
the refrigerator or freezer.
• If expressed breast milk required
storage for more than 4 days, freeze it
right away.
• Freeze breast milk in small amounts of 2
to 4 ounces.
Safe Storage tips:

9. • When freezing breast milk, leave about an inch of
space at the top of the container.
• Clearly label the container with the child’s name.
• Breast milk can be stored in an insulated cooler bag
with frozen ice packs for up to 24 hours.

10. • Always thaw the oldest breast milk first.
• There are several ways to thaw your breast
milk:
– In the refrigerator overnight.
– Set in a container of warm or lukewarm
water.
– Under lukewarm running water.
• Never thaw or heat breast milk in a
microwave.
Safe Thawing of Breast Milk

11. • Use breast milk within 24 hours of thawing in
the refrigerator.
• Once breast milk is brought to room
temperature it should be used within 2 hours.
• Never refreeze breast milk once it has been
thawed.

12. Human Milk Banking
• A human milk bank or breast milk bank
is a service which collects, screens,
processes, and dispenses by prescription
human milk donated by nursing mothers
who are not biologically related to the
recipient infant

13. When a mother, for some
reason, is unable to feed her
infant directly
• ,.,
her breastmilk should be
expressed and fed to the
infant(EBM)
If mother’s own milk is
unavailable or insufficient
the next best option is to use
pasteurized donor human milk

14. HISTORY
• Donating breast milk can be traced back to
the practice of wet nursing.
• The first record breastmilk donation are
found in the Babylonian Code of Hammurabi
(1800 BC).
• The practice of wet nursing declined by the
19th century
• Theodor Escherich of the University of
Vienna conducted studies from 1902 to 1911
to find out different sources of nutrition and
their effect on neonates.

15. • His studies demonstrated that breastfed
neonate's intestinal bacteria was significantly
different compared to neonates fed by other
means.
• In 1909, Escherich opened the first human
milk bank in Vienna , Austria .
• The following year, another milk bank opened in
the Boston Floating Hospital, the first milk bank
in the US.
• The first milk bank in Asia under the name of
Sneha, founded by Dr. Armeda Fernandez, was
started in Dharavi, Mumbai on November 27,
1989.
• Currently, the number of human milk banks
(HMB) has grown to nearly 14 all over India

16. • The International Milk Banking Initiative
(IMBI), was founded at the International
HMBANA Congress in 2005.
• It lists 33 countries with milk bank
programs.[6]
• Mothers' Milk Bank (MMB) says, this
service provides mothers with an
alternative to infant formula
• The World Health Organization (WHO)
states that the first alternative to a
biological mother not being able to breast
feed is the use of human milk from other

17. Primary Recipient/consumer
• The primary and largest group of consumers
of human breast milk are premature & sick
babies.
• The babies of mothers with postpartum
illnesses, and babies whose mothers have
lactation failure, till their milk output improves
• Infants with gastrointestinal disorders or
metabolic disorders may also consume this
form of milk as well.
• Human breast milk acts as a substitute,
instead of formula, when a mother cannot
provide her own milk.

18. Donor requirement
The donor population is formed by
healthy lactating mothers with healthy
babies,
who are voluntarily willing to give their extra
breast milk for other babies without
compromising the nutritional needs of their own
baby

19. Donor………………
A donor must:
• Be healthy
• Be in the process of lactation
• Undertake a chest x-ray or Tyne
test
• Have a negative VDRL
• Have no evidence of hepatitis
• Be HIV negative
.

20. LOCATION OF HUMAN MILK
BANKS
• The Human milk banks are primarily
focused to provide donor milk to high risk
newborns.
• The human milk banks in the neonatal
units is associated with elevated rates of
exclusive breastfeeding rates in VLBW
babies.
• The Postnatal wards or Well Baby
clinics of large hospitals are most
suited place.

21. Equipment & staff
• Breast milk pumps
• Container
• Generator/Uninterrupted power
supply
• Milk analyzer:
• Pasteurizer/Shaker-water bath
• Deep freezer
• Refrigerators
• Hot air oven/Autoclave
• STAFF

22. COLLECTION OF
BREASTMILK
•
,
• .
The proper counselling, checking suitability for
donation, getting written informed consent, history
taking, physical examination and sampling for
laboratory tests
the donor is sent to designated breastmilk collection
area in the milk bank or in the milk collection
center
Breastmilk is collected by trained staff with hygienic
precautions, after method of breastmilk expression is
chosen by the donor.

23. Processing
• All batches of collected raw breast milk
should be refrigerated
• Fresh raw milk should not be added to the frozen milk
• While mixing fresh raw breast milk to frozen raw
breast milk previously collected from same donor, it
should be chilled before adding to frozen milk [18].
• For sick or preterm babies, it is advisable to use a
new container for each pumping.
• Before pasteurization, pooling and mixing may be
carried out from multiple donors to ease the process
of processing and storage.

24. • Pasteurization is carried out by Holder’s
method.
• Microbiological screening of donor milk is done
before and as soon as possible after
pasteurization.
• Pre-pasteurization microbiology can result in
wastage of milk
• A bacterial count of 105 CFU/ mL or more in raw
breast milk can be considered as an indicator of the
poor quality of milk.
• Based on this and on the theoretical concern that
heavily contaminated milk with specific bacteria (e.g.
S. aureus, E.coli)

25. Storage
• Pasteurized milk awaiting culture report
should be kept in dedicated freezer/freezer
• Storage should be done in the same container
that is used for pasteurization.
• It is advisable not to transfer processed milk in
other containers as it has risk of contamination.
• Culture negative processed milk should be
kept at - 20°C in tightly sealed container with
clear mention of expiry date and other relevant
data on the label.
• It can be preserved for 3 to 6 months

26. Disbursal
• PDHM should be disbursed at physician’s
requisition from NICU physician after informed
consent from the parents of the recipient.
• Preterm baby should preferably get PDHM from
preterm donor.
• Transport of PDHM should be done under cold
storage in the same pasteurized container till its
use.
• Frozen PDHM should be thawed by either
defrosting the milk rapidly in a water bath at a
temperature not exceeding 370C, or under running

27. Labeling and record keeping
• HNB should have an operational objective of
ensuring full traceability from individual donation
to recipient,
• maintaining a record of all storage and
processing conditions.
• Written standard operating procedures should
be followed.
• Confidentiality of records should be maintained by
the milk bank.

28. • Proper labeling at all levels is mandatory; from
sterile container for collection of donation, pooling
vessel and pasteurization container to storage
containers.
• Labels should be water resistant and names and
identifying details of donors, dates of
pasteurization, batch numbers and expiry date
should be clearly readable.
• Record keeping at all levels should be meticulous
for
Donor Record File containing consent form,
donor’s and her child’s data, screening
reports, pasteurization batch files, and for

29. Thank
you