Increasing the Use of Human Donor Milk:

A Public Health Imperative

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Dixie Whetsell, MS, IBCLCBoard Member

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

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.

American Academy of Pediatrics,

Breastfeeding and the Use of Human Milk 2005

Courtesy Kingproductions.com

Human milk-fed premature infants receive significantbenefits with respect to host protection and improveddevelopmental outcomes compared with formula-fedpremature infants.

American Academy of Pediatrics 2005Breastfeeding and the Use of Human Milk

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

Oregon Health Insurers Partnering for Prevention

(OHIPP)

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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

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

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%

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.

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.

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.

• 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

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.

Why Develop A Milk Bank in Portland?

2007 US Breastfeeding Initiation Goal 75% - Dark Blue

Donor Milk Banks in North America

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 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

Donor Milk is Received and Logged In• 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 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

Donor Milk is Pasteurized and Cooled• 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.

Bacterial Testing and Milk Analysis• Testing is done

before and after pasteurization

Donor milk is analyzed for nutritional composition

-Protein-Carbohydrates-Fats-Calories

Donor Milk is Frozen and Stored

Donor Milk is Distributed to

Recipients

• Orders are received• Critically ill infants are

given priority• Frozen milk is boxed to fill

orders• Boxes are labeled and

shipped overnight

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

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.

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

Our first large fundraiser“Harvest”

September 2010Raised $30,000

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

March 2011Providence Health

Donates office space for 3 years In SW Portland for

Northwest Mothers Milk Bank

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!

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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