By Dr Raghuram Mallaiah
Human Milk Banks (HMB) are literally the lifeline for many preterm and low birth weight babies being born in our country. The importance of these HMBs can be gauged by the fact that almost all neonatal units in developed countries are serviced by a milk bank to cater to the needs of their premature babies.
The concept of milk banks are often misunderstood, HMBs are not meant to supply milk to normal term babies, but intended to save the lives of the most vulnerable babies in our society, such as the very premature and low birth weight babies.
Everyone knows the importance of breastfeeding, but breast milk in a preterm baby is actually lifesaving as it is protective, decreases infection and is easily digestible. Unfortunately, a lot of mothers who deliver preterm infants do not lactate initially to provide their own milk to their tiny little ones, when it is most needed. This is where HMB steps in to fill this void, by providing donor milk to these babies for the first few days of life till the mother starts lactating and starts providing her own milk (which is far superior to the milk from the bank).
Clinicians involved in the care of these babies should encourage mothers to pump out their milk from the moment the premature baby is born as this increases their chance of producing more milk at the earliest possible time. Mothers and clinicians should not look at milk banks as substitute for mothers’ own milk but rather as a stop gap arrangement only for the first few days of life till the mother starts producing her own milk.
HMBs have revolutionised the way in which we treat premature babies, by the fact that we can completely eliminate the use of formula feed for these babies in the NICU. Exclusive breast milk feeding, either mother’s own or donor milk from the bank or a combination of both, has shown to decrease infections and life threatening complications of the gut, improved survival and decreased hospital stay in preterm babies. This puts into clear perspective the importance of HMB in our society especially for the preterm and low birth weight babies.
Human milk banking is a society-based programme where a lactating mother, after feeding her own baby donates the excess amount of milk, to the HMB. The mother is screened for infections by the bank before accepting her milk. The donor mother’s milk is then pasteurised, to make it safe for consumption by the preterm baby, in the Neonatal Unit. This milk is further screened for infections before dispatch. As this donor milk is very precious like liquid gold, this milk is given only to the preterm/low birth weight who are admitted in the Neonatal units.
In India, most milk banks are established within hospitals and the milk from these banks is used only for babies admitted in their own neonatal unit. A much more cost-effective way is to establish public HMBs which pool milk from a particular geographical area and then distribute the donor milk to all vulnerable babies who are admitted in different hospitals in that entire area. For this system to be effective one needs to have an excellent collection and distribution network.
It would be important to set up more public human milk banks to meet the ever-growing needs of a country like India where almost 13 per cent of all babies born are preterm and many more are very low birth weight babies.
(The writer is Director Neonatology, Fortis La Femme – New Delhi.)