Human Milk Bank Processes: YOUR FACILITY AND LOCATION

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Human Milk Bank Processes YOUR FACILITY AND
LOCATION
Guido E. Moro, MD President of Associazione
Italiana Banche del Latte Umano Donato
(AIBLUD) Milan, Italy Email guidoemoro_at_tiscali.it
Tel. [phone]
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HUMAN MILK BANKING IN ITALY TWENTY-
SEVEN MILK BANKS IN 2012
TRENTINO ALTO ADIGE Trento Dr. Giuseppe De Nisi,
Head Nurse Maria Luisa Zattoni
LOMBARDIA Milano
PIEMONTE Torino Prof. Enrico Bertino, Head Nurse
Elisabetta Punziano Moncalieri Dr. Antonio Marra,
Ms Patrizia Soriani
Friuli Venezia Giulia Udine Head Nurse Monica
Fantini Pordenone Dr.Alberto Coprivez, Head Nurse
Helene Huber, Ms Gianna Polletti
VENETO Camposampiero Prof. Carlo Zorzi, Head
Nurse Mariuccia Bruseghin Treviso Prof. Onofrio
Sergio Saia
EMILIA ROMAGNA Cesena Dr. Augusto
Biasini Modena Prof. Fabrizio Ferrari, Dr. Bruno
Mordini, Head Nurse Giovanna Cuomo Reggio
Emilia Dr. Giancarlo Gargano, Dr. Claudio Rota
TOSCANA Arezzo Dr. Pier Giorgo DAscola, Ms
Manuela Caneschi Firenze Dr. Claudio Profeti, Dr.
Fina Belli Grosseto Dr. Rita Bini, Ms Sandra
Novelli Lido di Camaiore Dr. Ilaria Merusi, Ms
Alessandra Manfredi Lucca Dr. Raffaele Domenici,
Dr. Simona Tognetti, Ms Bruna Giampaoli Siena Prof
. Mirella Strambi, Ms Angela Polese
ABRUZZO Chieti Dr. Mariangela Conte, Ms Lucilla
Campione
PUGLIA Bari Dr. Antonio del Vecchio, Ms Ottavia
Binetti Foggia Dr. Giovanna Minelli, Dr.
Rosario Magaldi
San Giovanni Rotondo, Foggia
Dr. Alberto Gatta, Dr. Antonio Villani,
Dr. Pasqua Quitadamo
LAZIO Roma Dr. Giuseppe Morino, Dr. Anna Maria
Cappelli
CALABRIA Cosenza Dr. Maria Pia Galasso, Ms
Francesca De Luca Crotone Dr. Massimo Bisceglia,
Dr. Vincenzo Poerio
SICILIA Agrigento Dr. Adriano Azzali, Head Nurse
Fazeo Gioachino Palermo Dr. Iwona Kazmierska
FOR COMMUNICATION
Italian Association of Human Milk Banks -
Associazione Italiana Banche del Latte Umano
Donato (AIBLUD) Adress c/o Biomedia, Via
Libero Temolo 4, 20126, Milan, ITALY Website
www.aiblud.org Secretariat Cristina Benelli
Tel. [phone]
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Background info
Brief description
How did your human milk bank (HMB) began? When? Collecting Human Milk to feed premature infants admitted to the NICU of Macedonio Melloni Maternity Hospital, the second largest maternity in Milan. It began in the year1985.
Who provided initial funding? How are ongoing operations funded? Integrated into government services? It started as a Service of the Hospital. Part of the funds were given from the Italian National Council of Research, part from private donation, and part from the Hospital. After that, it became a regular service supported by the hospital (National Health Service).
Who regulates /oversees HMB in your country/region (if any)? No official organization regulates/oversees HMB. The banks are following the Italian Guidelines published in 2005, revised in 2007 and in 2010. In the year 2012, Italian National Recommendations for the Organization and Management of HMB have been published as the result of a cooperation between the Italian Ministry of Health and the Italian Association of Human Milk Banks (AIBLUD). According to this agreement, the National Health Service will monitor the functioning of HMB through AIBLUD.
How many HMBs are part of your system? Where are they? 27 (26 are included in hospitals and belong to the Public Health Service, 1 bank is managed by a private diary company). They are located mainly in the North and Center of our country.
Is there a central HMB that processes milk and distributes or many HMBs that process milk and distribute? All the banks are processing and distributing the milk.
How many NICU/Neonatal wards/community homes does each bank serve? Are they collocated? The majority of the banks are serving mainly their own NICU, but some are serving also 2-3 other NICUs of the same region.
How many babies does your facility/system serve annually? All the babies with a BW lt 1800 g admitted to the NICU (app. 90), plus the infants lt 1250 g admitted to the NICU of Lecco Hospital (app. 20 babies), plus 25-30 external babies.
How many liters/year does your facility/system process annually? In the year 2010 we have collected and processed 1,500 liters of donated human milk.
How many donor mothers initiate donation to your facility/system annually? In the year 2010 we had 222 donors (135 internal mothers of premature infants, and 87 external mothers of term infants).
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Process
Brief description of processes
Staffing 1 full time nurse 1 part time doctor
Donor recruitment Interview
Donor screening Life style Maternal therapies Maternal diseases and serological testing
Recipient eligibility and selection According to the Italian Guidelines (Journal of Maternal-Fetal Neonatal Medicines, September 2010 23(S2) 1-20)
Handling and storage of donor milk (from donation to feeding) According to the Italian Guidelines (Journal of Maternal-Fetal Neonatal Medicines, September 2010 23(S2) 1-20)
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Process
Brief description of process
Transport of milk Home service with a car of the hospital
Pasteurization Holder pasteurization
Tracking and record keeping Routinely performed
Assessing milk quality and safety (ie. microbiology assays) Pre-pasteurization testing 1) at the first donation 2) when the donor does not seem to guarantee appropriate hygienic conditions 3) periodically, in a random way Post-pasteurization testing 1) in a regular way (e.g. once a month or every 10 cycles) 2) when there are concerns about the processing
Quality assurance According to the principles of Hazard Analysis and Critical Control Points (HACCP)
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Equipment/Location
Brief description of process
What is used/how many? Pasteurizer 1 Sterifeed Freezers 3 freezers at 20C Refrigerators 2 refrigerators
Additional HMB equipment requirements? Computer 1 devoted to the bank Other Milk Scan Analyzer (Foss Electric) osmometer (De Mori)
Referral/feeder/depot facilities? How many? Equipment requirements?
Neonatal ward equipment requirements? System for tracking usage? Freezer?
Other?
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Organizational Successes
Brief description of top 3-5 successes
Policy National policy and support for breastfeeding. Impact of breastfeeding promotion on HMB impact of HMB on breastfeeding promotion (increased number of breast feeding mothers at discharge home in the NICU with a HMB national survey. Exclusive breastfeeding at discharge in the 19 NICU with HMB 29.6 vs 16 of the 64 NICU without HMB. Any breastfeeding 60.4 in NICU with HMB vs 52.8 in NICU without) .
Operational Impact of HMB on infant health outcomes (reduced incidence of NEC, sepsis, and better feeding tolerance). Utilization of donated human milk in the nursery (supplementation of mothers milk in term infants in the first days of life in specific circumstances e.g. excessive loss of weight, dehydration).
Technology Macronutrient evaluation of donated human milk, and storage of the milk according to the protein content.
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Organizational Challenges
Brief description of top 3-5 challenges
Policy Lack of interest from Regional Government Economical crisis Some neonatologysts do not believe in HM for feeding VLBW infants
Operational Continuous update of the staff to maintain a high level of qualification.
Technology Pasteurization method should be improved to preserve better the nutritional and biological quality of human milk, maintaining at the same time the microbiological safety of the final product.