Storage and Use of Human Milk in Neonatal Intensive Care Units

KEY POINTS

• 1.

  Human milk is an important source of nutrients, immunologic factors, and pre- and probiotic factors for preterm and critically ill infants for up to 6 months after birth.

• 2.

  Human milk has positive effects on enhanced maturation of vital organs such as the brain and gastrointestinal system and on immunity, and it is also known to protect at-risk infants against neonatal morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity.

• 3.

  Because mother’s own milk is not always available for all critically ill infants, neonatal intensive care units (NICUs) have/are developing storage facilities for the storage, screening, processing, and careful use of human milk in ill infants.

• 4.

  In this chapter, we have summarized the information/guidelines for the development of physical infrastructure and human resources for milk storage units in NICUs.

• 5.

  There is a need for continued education of mothers about the importance of human milk and its storage, screening for infectious agents, and measures to improve safety of infant feeding with mother’s own or stored donor milk.

Introduction

Human milk has a unique composition, and consequently, has unique bioactive properties that differ from milk from other mammals ( Fig. 17.1 ). Breast milk not only meets complete nutritional needs of a newborn infant ( Fig. 17.2 ) up to 6 months but also plays a vital role in development of the brain and immune system, and it has been constantly emphasized in literature. In-depth analyses show unique structural patterns in human milk-borne carbohydrates, which may have far-reaching effects and even after the patterns of gut microbial colonization extending into later infancy and beyond ( Fig. 17.3 ). All these attributes make breastfeeding the single most cost-effective intervention to reduce infant mortality across the globe. Although all newborn infants benefit from breast milk, not all are able to breastfeed at birth, which majorly includes preterm and low birth infants. The benefits of breast milk remain irreplaceable in preterm neonates. Prevention of prematurity-related morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity; better intestinal maturity; and improved neurodevelopmental outcomes are a few advantages. ^, Succinctly, the most vulnerable population of newborns is at the greatest risk of increased mortality and morbidity and is not able to receive the benefits of breast milk. However, initiation and maintenance of mother’s own milk (MOM) are of global concern in neonatal intensive care units (NICUs). The World Health Organization and European Society for Paediatric Gastroenterology, Hepatology, and Nutrition recommend pasteurized donor human milk as the next best option if MOM is not available. This chapter outlines the basic requirements and principles for developing facilities in various NICUs for storage of MOM, and if possible, milk from mothers willing to share if there are volumes more than those needed for their own infants. For donated milk, a set of procedures needs to be developed similar to those used in larger milk banks to ensure safety from any infectious agents.

Definition

Human milk storage facilities in NICUs store, screen, process, and use human milk to feed the infants. These units promote, protect, and support breastfeeding by providing safe and appropriate storage to provide high-quality human milk to premature and critically ill infants. Such units also help prevent waste of this important resource during periods when the infant cannot be fed due to medical reasons.

Infrastructure of Human Milk Storage Units in NICUs

The use and processing of human milk for use in the newborn infant units and NICUs is summarized in Fig. 17.4 . In the following sections, we describe the structural and functional needs for developing a human milk storage unit in a hospital. We realize that the chapter is relatively weighted toward the policies and procedures needed for processing donated milk, but these details are needed to prevent infections and transmission of unknown toxins and to ensure safety when an infant is fed with donated milk. The procedures to ensure safety of using mothers’ own and donated milk have been defined but need periodic reevaluation ( Fig. 17.5 ).