Human Milk Banking: Successes and Challenges
Successes: Policy
• Government backing• National and regional policies and guidelines developed• Funding support
• Facility backing and engagement• Interdisciplinary teams for optimizing human milk nutrition
• Advocacy and awareness raising • HMB and breastfeeding promotion• Mass media/peer-review journals
• Recognition of successfully implemented system• Integration of messaging
• Neonatal care guidelines include DBM• Impact on breastfeeding practices• Health system cost-savings• Adoption of system to other NICUs
Successes: Operational• Impact on breastfeeding
• Provision of DHM results in increased initiation of breastfeeding in the NICU units
• NICUs with highest BF rates have attached HMB• BF rates higher than formula in discharged NICU infants• Increased BF duration among donors
• Long-term continuous operations• Improved health outcomes
• DHM and supplementation of MOM • Leveraging support from volunteer blood/tissue transport
services (bikes, motorcycles)• Integrated/holistic approach through HMB providing lactation
support and assistance
Successes: Technological
• Improved screening, processing, tracking• Refined and/or simplified systems/equipment/supplies• Ability to assess macronutrient and protein content
• Validated systems• Online accessibility
• Screening, marketing, ordering, prescriptions• Standardized quality assurance and outcome reporting
Challenges: Policy
• Achieving policy level support• HMB and supporting breastfeeding, ie MOM,
lactation support• HMB integrated into other health programs
• Implementing legislation to regulate and standardize HMB
• Uncertainty of DHM importance among health care staff• Establishing sufficient donor base• Balancing promotion of DHM and capacity to meet need
• Supply and demand
Challenges: Policy
• Limited/no financial support from government• Limited/no leadership or interest from government• Economic crisis• Becoming established as regional centre of reference• Expansion to other areas limited by cultural/tribal
concerns• Lack of insurance coverage• For profit and casual sharing impacting donor base
Challenges: Operational
• Identifying and retaining qualified staffing• Depending volunteers not sustainable• Lack of funds for salaries• Refresher trainings needed
• Inadequate training• Need to develop HMB specific training program
• Insufficient donor milk due to insufficient donors• Lack of breastfeeding promotion and support
• For profit and informal milk sharing impact donor base• Lack of eligible donors due to high HIV prevalence• Maintaining consistent demand for DHM from hospitals
to enable growth
Challenges: Operational
• Implementing transport for milk collection• Implementing a communication plan• Need low cost distribution methods• Need protected and effective on-line screening process• Centralized care model changing to accommodate other
level III NICUs• Increased demand could be seen as opportunity for
strengthening preterm lactation success• Limited space• Implementing HACCP
Challenges: Technological
• Achieving optimal pasteurization throughput balanced against wastage• Matching batch volumes with distribution volumes• Need for pasteurizing small volumes
• Time for processing• Defrosting takes a long time
• Introducing electronic testing and reporting systems, bar code tracking systems
• Need for improved pasteurization systems to preserve nutritional and immunological properties – balanced with microbial safety
Challenges: Technological
• Low cost bottling units that do not retard or chip • Low cost standard methods for testing human milk
• medications, contamination and nutritional analysis • Shipping units specifically for human milk • Mechanized processing equipment
• Provides homogenized milk• Pouring accuracy
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