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Donor human milk (DHM) from a milk bank is the recommended feeding method for preterm infants when the mothers own milk (MOM) is not available. Despite this recommendation, information on the possible contamination of donor human milk and its impact on infant health outcomes is poorly characterised. The aim of this systematic review is to assess contaminants present in DHM samples that preterm and critically ill infants consume. The data sources used include PubMed, EMBASE, CINAHL and Web of Science. A search of the data sources targeting DHM and its potential contaminants yielded 426 publications. Two reviewers (S. T. and D. L.) conducted title/abstract screening through Covidence software, and predetermined inclusion/exclusion criteria yielded 26 manuscripts. Contaminant types (bacterial, chemical, fungal, viral) and study details (e.g., type of bacteria identified, study setting) were extracted from each included study during full-text review. Primary contaminants in donor human milk included bacterial species and environmental pollutants. We found that bacterial contaminants were identified in 100% of the papers in which bacterial contamination was sought (16 papers) and 61.5% of the full data set (26 papers), with the most frequently identified genera being Staphylococcus (e.g., Staphylococcus aureus and coagulase-negative Staphylococcus) and Bacillus (e.g., Bacillus cereus). Chemical pollutants were discovered in 100% of the papers in which chemical contamination was sought (eight papers) and 30.8% of the full data set (26 papers). The most frequently identified chemical pollutants included perfluoroalkyl substances (six papers), toxic metal (one paper) and caffeine (one paper). Viral and fungal contamination were identified in one paper each. Our results highlight the importance of establishing standardisation in assessing DHM contamination and future studies are needed to clarify the impact of DHM contaminants on health outcomes.

BackgroundGlobally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle-income countries. In the absence of mother's milk, the World Health Organization recommends using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal disorder. The use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality, yet very little is known about the nutritional composition of DHM. Additional knowledge gaps include how DHM composition is influenced by milk banking practices, and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers.MethodsWe designed a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings that will examine and compare a broad range of nutrients and bioactive factors in human milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM. We will then simulate the random pooling of 2 to 10 donors to evaluate the impact of pooling as a potential strategy for milk banks to manage nutrient variability in DHM. Finally, we will evaluate whether commercially available fortifiers meet nutrient recommendations when used with DHM.DiscussionWe expect that results from this study will improve nutritional care globally for the growing number of preterm infants who receive donor human milk.

Maternal diet influences breast milk nutritional profile; however, it is unclear which nutrients and contaminants are particularly responsive to short- and long-term changes in maternal intake, and the impact of specific exclusion diets, such as vegan or vegetarian. This study systematically reviewed the literature on the effects of maternal nutrient intake, including exclusion diets, on both the nutrient and contaminant content of breast milk. The electronic databases, PubMed, CENTRAL, Web of Science and CINALH were systematically searched until 4 June 2023, with additionally searches of reference lists (PROSPERO, CRD42020221577). The quality of the studies was examined using Cochrane Risk of Bias tool and Newcastle–Ottawa scale. Eighty-eight studies (n 6577) met the search criteria. Due to high heterogeneity, meta-analysis was not possible. There was strong evidence of response to maternal intakes for DHA and EPA, vitamins A, E and K, iodine and Se in breast milk composition, some evidence of response for α -linolenic acid, B vitamins, vitamin C and D, ovalbumin, tyrosine and contaminants, and insufficient evidence to identify the effects arachidonic acid, Cu, Fe, Zn and choline. The paucity of evidence and high heterogeneity among studies reflects the need for more high-quality trials. However, this review identified the importance of maternal intake in the nutritional content of breast milk for a wide range of nutrients and supports the recommendation for supplementation of DHA and vitamin B12 for those on restrictive diets. [ABSTRACT FROM AUTHOR]

This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and “professional supremacy” operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health & Life Sciences / Sağlık ve Yaşam Bilimleri Dergisi is the property of Istanbul Kultur University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Breastfeeding mothers’ decisions to donate their milk is influenced by their knowledge, attitudes, and subjective norms such as their family’s opinions on milk donation. In Iran, women have favorable knowledge and positive attitudes toward breastfeeding, but they lack sufficient information and education about milk banks. With respect to current childbearing policies, an increase in the number of infants who will be admitted to neonatal intensive care units is expected. Accordingly, improving milk donation behavior, which requires mothers’ intention and ability to donate breast milk, is important for infants’ survival and well-being. Therefore, this study aims to evaluate whether an educational program based on the theory of planned behavior affects breastfeeding mothers’ decisions to donate their breast milk. Methods This cluster randomized controlled trial will be conducted in health centers affiliated to Tehran University of Medical Sciences and will enroll 66 breastfeeding mothers (intervention, n = 33; control, n = 33). After collecting baseline data, the intervention group will begin receiving a 60-minute weekly educational program based on Theory of Planned Behavior components for four weeks. The first follow-up assessment will be conducted immediately after the intervention, and the final one will be conducted 12 weeks later. The primary outcomes are the number of mothers who have donated their breast milk and changes in breastfeeding mothers’ knowledge, attitude, subjective norms, and perceived behavioral control about donor human milk and intention to donate milk. Discussion This trial will evaluate if a well-designed educational program can improve breastfeeding mothers’ knowledge and promote their behavioral factors regarding milk donation and lead to a significant increase in the number of potential milk donors. Trial registration irct.ir (IRCT20230124057203N1) registered February 14, 2023.

Background: Breastfeeding mothers' decisions to donate their milk is influenced by their knowledge, attitudes, and subjective norms such as their family's opinions on milk donation. In Iran, women have favorable knowledge and positive attitudes toward breastfeeding, but they lack sufficient information and education about milk banks. With respect to current childbearing policies, an increase in the number of infants who will be admitted to neonatal intensive care units is expected. Accordingly, improving milk donation behavior, which requires mothers' intention and ability to donate breast milk, is important for infants' survival and well-being. Therefore, this study aims to evaluate whether an educational program based on the theory of planned behavior affects breastfeeding mothers' decisions to donate their breast milk. Methods: This cluster randomized controlled trial will be conducted in health centers affiliated to Tehran University of Medical Sciences and will enroll 66 breastfeeding mothers (intervention, n = 33; control, n = 33). After collecting baseline data, the intervention group will begin receiving a 60-minute weekly educational program based on Theory of Planned Behavior components for four weeks. The first follow-up assessment will be conducted immediately after the intervention, and the final one will be conducted 12 weeks later. The primary outcomes are the number of mothers who have donated their breast milk and changes in breastfeeding mothers' knowledge, attitude, subjective norms, and perceived behavioral control about donor human milk and intention to donate milk. Discussion: This trial will evaluate if a well-designed educational program can improve breastfeeding mothers' knowledge and promote their behavioral factors regarding milk donation and lead to a significant increase in the number of potential milk donors. Trial registration: irct.ir (IRCT20230124057203N1) registered February 14, 2023. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine perceptions and experiences of women who donate human milk and highlight various aspects of the breast milk donation process. Study Design: A cross-sectional descriptive study. Methods: An online survey was conducted with a convenience sample of women who donated milk at several milk banks in the United States. A questionnaire of 36 closed and open-ended items were developed and validated by the research team. Descriptive statistics and content analysis were used. Semantic content analysis involved three procedures: coding, categorizing text units, and refining the identified themes. Results: A total of 236 women who donated breast milk completed the questionnaire. Mean age of participants was 32.724.27 and 89.40% were non-Hispanic White women with a bachelor's degree (32.20%) or graduate degree (54.70%). Most participants were women who actively donated breast milk, ranging from one to four times. Two themes, facilitators and barriers of milk donation, were Identified. Facilitators to milk donation included attitudes toward milk donation, commitment for donating, motivation in donating, and support. Barriers included personal factors, environment, milk donor process, and psychosocial factors. Clinical Implications: Nurses, health care providers, and lactation professionals should educate women about milk donation resources and opportunities. Strategies to increase awareness about milk donation among underrepresented groups such as women of color are highly recommended. Future research is needed to further explore specific factors that increase milk donation awareness and minimize barriers to potential donors. [ABSTRACT FROM AUTHOR]

Introduction: This research was conducted to determine the opinions of breastfeeding mothers regarding breast milk banking. The aim of this study was to investigate the attitudes of breastfeeding mothers towards breast milk banking and to determine the potential impact of education on increasing knowledge and awareness of breast milk donation. Methods: The study was carried out with 303 breastfeeding mothers who presented to the healthy child and general pediatrics clinics between April 15, 2020 and September 1, 2020, for various reasons. After a brief information session on breast milk banking, a 20-question survey was conducted face-to-face with the mothers. The questions related to breast milk banking in the survey were prepared according to the literature. The first part of the survey included demographic questions about the mothers, and the second part included questions about breast milk banking. Results: The mean age was found to be 32.6±5.9 years. 67.7% of the mothers had heard of breast milk banking before, while 73.6% did not know if there was a breast milk bank in Turkey. Additionally, 61.7% of the mothers had a positive view of donating breast milk, and 76.2% stated that they could give their milk to another baby if there was a need. As the education level of the mothers increased and the number of pregnancies exceeded three, the rates of those who considered donating breast milk and those who stated that they could use donor milk for their own children if necessary were found to be statistically significant (p lt;0.05). Conclusion: As the education levels and number of pregnancies of the participating mothers increased, the rates of those considering donating breast milk also increased. The most significant difference of our study compared to other similar studies is that, with the brief information provided to the mothers during the study, their knowledge and awareness increased, and they indicated that they could donate their milk to breast milk banks and use donor milk for their own children when necessary. Providing education to mothers about breast milk banks in our country can have a positive impact on establishing breast milk banks. In addition, it is believed that increasing women's education levels is important not only for their own babies but also for providing milk to all high-risk babies in the society. Keywords: Breast Feeding; Health Knowledge, Attitudes, Practice; Infant; Milk Banks; Human Milk

Abstract: The objective of this study was to describe the frequency of cross-breastfeeding, human milk donation to human milk banks and reception of human milk from human milk banks, and to investigate the intersection between cross-breastfeeding and breast milk donation practices. This study used data from the national household-based survey Brazilian National Survey on Child Nutrition (ENANI-2019), which collected information from 14,558 children < 5 years old between February 2019 and March 2020. The present study included data from 5,831 biological mothers who reported having breastfed their child < 2 years old at least once and replied questions about cross-breastfeeding, donation and recaption of human milk to human milk banks. Prevalence and 95% confidence intervals (95%CI) were estimated for each stratifier, considering the study complex sample design. Among mothers of children < 2 years old who breastfed their child at least once, 21.1% practiced cross-breastfeeding; breastfeeding another child was more frequent (15.6%) than allowing a child to be breastfed by another woman (11.2%). Among this population, 4.8% of women donated human milk to a human milk bank, and 3.6% reported that their children had received donated human milk. The donation of human milk is a practice recommended by the Brazilian Ministry of Health and has the potential to save thousands of newborns throughout Brazil. In contrast, cross-breastfeeding is contraindicated due to the potential risk of transmitting HIV. There is a need for a broad debate on these practices in Brazil and worldwide.

Background: breast milk is the ideal food for newborns and infants, but there are factors that can prevent the practice of breastfeeding. Human milk banks (BLH) are a strategy to increase breastfeeding coverage; the donated milk is subjected to Holder pasteurization to guarantee its innocuousness, undergoing large changes in temperature and a decrease in the concentrations of biocomponents such as Immunoglobulin A (IgA) and lactoferrin (LF). This article describes the results of recent studies on the impact of Holder pasteurization on IgA and LF in human milk. Material and methods: a search for research articles related to the topic of interest was carried out in various databases and in accordance with inclusion criteria that considered the type of study, date of publication and quality of the journal. Results: the impact of Holder pasteurization on IgA and LF concentrations is not clear, given that the literature reports a variety of protocols and different results; however, the percentage reductions of both biocomponents are significant and consistent in the studies reviewed, suggesting the importance of establishing a standard protocol for their quantification. Conclusions: Holder pasteurization guarantees the microbiological quality of the milk distributed in HMB, but affects the amount of beneficial biocomponents for the final recipient. Government entities that regulate HMBs should evaluate the possibility of using other techniques that reduce the impact on biocomponents while preserving the microbiological quality of the product. [ABSTRACT FROM AUTHOR]

Abstract Objectives: microbiological quality of raw human milk (HM) from donors at the HMB (Human Milk Bank) of Santa Casa de Misericórdia de Ouro Preto was evaluated. Methods: the microbiological quality of milk from each of 10 donors in triplicate (30 samples) was evaluated by enumeration of Staphylococcus aureus and total aerobic mesophiles (surface plating) and total and thermotolerant coliforms (Most Probable Number - MPN). A questionnaire and a checklist were applied after the end of sample collection to verify the compliance of milk extraction and storage procedures by the donors. Results: inadequacies in the procedures for expression and storage of donated HM were observed. The presence of all microorganisms studied were verified in the milk of all donors, and in some cases exceeded the safety limits. The checklist indicated that some necessary hygienic-sanitary procedures were not carefully performed, making it important to properly guide the donors. Conclusions: this study points to an unfavorable scenario for the safety and quality of donated HM, and it is important to encourage further studies to be conducted so that the Brazilian network of HMB adopts stricter criteria for instructions on procedures and support for HM donors.

Objective: To describe the trend of participation in group and individual support by human milk banks (HMBs) provided between 2010 and 2019 in Brazil. Methods: Ecological study with data from participation in group and individual support provided by the HMBs between 2010 and 2019, available in the production report of the Brazilian Network of Human Milk Banks. The number of participation in group and individual support was expressed for Brazil and for Brazilian macroregions in absolute numbers. Trend analysis was performed from the analysis of index numbers, considering the year 2010 as a reference. It was calculated the ratio of the number of participation in group and individual support by HMBs for each macroregion and year. Results: There was an increase of 42% in participation in group support (300,595 in 2010 vs 425,570 in 2019) and an increase of 69% in individual support (1,157,038 in 2010 vs 1,962,162 in 2019). The North and Northeast macroregions had the highest growth rates in the provision of these services (122 and 131%, respectively), above the national growth rate in the study period. In contrast, the Midwest region showed a downward trend throughout this period, for both types of support. However, in the Midwest, there was a higher ratio of participation in groups by HMBs between 2010 and 2016 and for individual support by HMBs between 2010 and 2012. Conclusion: Individual and group support provided by the HMB as a strategy to support breastfeeding increased considerably in Brazil during the study period, especially in the North and Northeast regions.

Breastfeeding is essential in reducing neonatal mortality. The human milk banks (HMB), in addition to their performance in the collection and processing of milk, also promote actions to protect and support breastfeeding. This study aimed to report the practices of biomedical residents in a HMB of a child-friendly hospital during the COVID-19 pandemic. As a result of this scenario, all protocols of the BLH have been revised. As activities developed at the BLH in this period, were the reception and registration of nursing mothers at scheduled times to avoid crowding and the mandatory use of a mask; and compliance with all hygiene measures by donors was essential to avoid contamination. The stages of human milk processing have not been altered, since they were already carried out with strict quality control. Due to social isolation, there was a significant reduction in the attraction of external donors and, consequently, a decrease in the amount of milk for distribution. Questions about the possible protection by neutralizing antibodies from the mother as well as the possibility of infection through breast milk were outstanding. Despite this, in updates, the World Health Organization has not recommended mother-infant separation. However, donation by women with suspected infection was contraindicated. In this context, still remains a challenge to increase the number of donor breastfeeding mothers and milk collected, therefore, it is necessary to adopt strategies that reverse this state, covering the entire multidisciplinary team and society. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to unveil the value meanings of nurses in a human milk bank about nursing teleconsultation. Method: A phenomenological study based on Max Scheler's Theory of Values, with phenomenological interviews conducted in October and November 2022 with five nurses from a human milk bank in the second metropolitan region of Rio de Janeiro. The data collected was then subjected to Bardin's thematic analysis. Results: two categories emerged: Nursing teleconsultation and nurses' actions in the human milk donation process in times of Covid-19 - an expansion value; Nursing teleconsultation in the care of donors and infants assisted at the human milk bank - a useful health value. Conclusion: teleconsultation was understood as having values that expand and guarantee care, improving the representation of access for users, collaborating with the continuity of breastfeeding and the donation of human milk. [ABSTRACT FROM AUTHOR]

Human milk is in increasing demand. The health benefits of human milk for infants are well known. A limited number of formal Australian milk banks provide human milk to premature and sick infants. However, growing numbers of adults and parents from non-traditional families of healthy infants are buying and sharing it from the internet and social media sites for consumption. In Australia, human milk is not legally defined as a tissue or a food. Its donation, exchange, or sale is also unregulated. This is a precarious situation, as unscreened and potentially unsafe human milk is being provided to the most vulnerable members of society – infants. This article calls for human milk to be legally defined, and the current regulatory vacuum to be addressed. We recommend a consistent and uniform network of human milk banking and sharing where the safety of donors and recipients is protected. We argue that this might be achieved by defining human milk as a tissue, undergoing screening and storing practices similar to those currently used for blood donation. [ABSTRACT FROM AUTHOR]

Objective: To describe the trend of participation in group and individual support by human milk banks (HMBs) provided between 2010 and 2019 in Brazil. Methods: Ecological study with data from participation in group and individual support provided by the HMBs between 2010 and 2019, available in the production report of the Brazilian Network of Human Milk Banks. The number of participation in group and individual support was expressed for Brazil and for Brazilian macroregions in absolute numbers. Trend analysis was performed from the analysis of index numbers, considering the year 2010 as a reference. It was calculated the ratio of the number of participation in group and individual support by HMBs for each macroregion and year. Results: There was an increase of 42% in participation in group support (300,595 in 2010 vs 425,570 in 2019) and an increase of 69% in individual support (1,157,038 in 2010 vs 1,962,162 in 2019). The North and Northeast macroregions had the highest growth rates in the provision of these services (122 and 131%, respectively), above the national growth rate in the study period. In contrast, the Midwest region showed a downward trend throughout this period, for both types of support. However, in the Midwest, there was a higher ratio of participation in groups by HMBs between 2010 and 2016 and for individual support by HMBs between 2010 and 2012. Conclusion: Individual and group support provided by the HMB as a strategy to support breastfeeding increased considerably in Brazil during the study period, especially in the North and Northeast regions. [ABSTRACT FROM AUTHOR]

Objective: To verify the acidity titration and caloric profile of human milk pasteurized in a milk bank of the State of Pernambuco. Methodology: This is a retrospective cross-sectional descriptive study of quantitative approach, developed in the Human Milk Bank of Hospital Barão de Lucena, in Recife-PE. The research used secondary data from the record sheets of the acidity and crematocrit tests in 2019. Results: A total of 1,411 acidity titration tests were performed, the milk with acidity standards above 8º Dornic, totaled 58 samples that were discarded. Of the total, 1,113 crematocrit tests were performed, of which 418 (37.5%) samples were considered hypocaloric, 516 (46.4%) normocaloric and 179 (16.1%) hypercaloric. The caloric value of the analyzed milks ranged from 357 kcal/L to 1,046 kcal/L, with a mean value of 618.7 kcal/L. Conclusion: Most of the milk has appropriate acidity values and calorie profile for consumption.

Objectives: microbiological quality of raw human milk (HM) from donors at the HMB (Human Milk Bank) of Santa Casa de Misericórdia de Ouro Preto was evaluated. Methods: the microbiological quality of milk from each of 10 donors in triplicate (30 samples) was evaluated by enumeration of Staphylococcus aureus and total aerobic mesophiles (surface plating) and total and thermotolerant coliforms (Most Probable Number - MPN). A questionnaire and a checklist were applied after the end of sample collection to verify the compliance of milk extraction and storage procedures by the donors. Results: inadequacies in the procedures for expression and storage of donated HM were observed. The presence of all microorganisms studied were verified in the milk of all donors, and in some cases exceeded the safety limits. The checklist indicated that some necessary hygienic-sanitary procedures were not carefully performed, making it important to properly guide the donors. Conclusions: this study points to an unfavorable scenario for the safety and quality of donated HM, and it is important to encourage further studies to be conducted so that the Brazilian network of HMB adopts stricter criteria for instructions on procedures and support for HM donors. [ABSTRACT FROM AUTHOR]

Objective: To learn about the experiences of women who are milk donors and users of the human milk bank, who are mothers of pre-term infants, low birth weight infants and sick newborns hospitalized in a neonatal intensive care unit (NICU). Method Descriptive, qualitative, micro ethnographic study following the method proposed by James Spradley, focused semi-structured interviews were conducted with 10 human milk donor/receiver mothers. Results: six categories were established: human milk for humans, motivation and maintenance of human milk donation, recognition of Human Milk Banks (HMLB) as a suitable place for donation, donating human milk requires commitment and technique, feelings of women donors and recipients, barriers to donation, from these categories emerged the central category "Donating human milk saves lives" Conclusions Donating and receiving human milk is an experience in which biological, cultural, emotional and political aspects are linked. Women demand social recognition of the work of Human Milk Banks in the promotion, protection, support of breastfeeding, nutrition and protection of premature and sick newborns in neonatal units. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization prioritizes Mother's Own Milk (MOM) or donor human milk (DHM) when MOM is unavailable or insufficient. It is also important for healthcare workers (HCWs) to provide adequate support, information, and education to mothers to help improve their milk production and breastfeeding experience. DHM is scarce in developing countries, prompting a need for understanding health workers' perspectives., Methods: This cross-sectional study, conducted in 2021 in Ekiti State, Nigeria, examined the knowledge and attitudes of HCWs regarding human milk banking. A sample of 321 participants from government-owned hospitals completed a self-administered questionnaire., Results: Of the 321 participants (84.7% response rate), the majority were females (69.2%), aged 30-39 (32.1%), Christian (91.9%), and employed in tertiary hospitals (91.9%). About 65% of the HCWs believe that HMB is a safe practice and 42% believe that the DHM has the same quantity of immunological factors as fresh human milk. While 80.4% displayed good DHM knowledge, attitudes varied. The HCWs profession influenced their attitudes and a higher proportion of all female HCWs (71%), except for health assistants (65.4%), expressed willingness to donate their breast milk if needed. Among males HCWs, the majority of those who were doctors (82.8%) and pharmacists (62.5%) expressed willingness to support their spouses to donate breast milk, and they also had higher acceptance of DHM for their infants. In all, more than 80% of the HCWs will encourage mothers to donate their milk and feed babies under their care with DHM, but only 47% would accept DHM to feed their own children. Health assistants had less favourable views, and negative perceptions were linked to the internet and media sources., Conclusions: The study highlights health workers' awareness of DHM but indicates a reluctance to fully embrace it, especially among health assistants. The need for targeted education programs, to address knowledge gaps and negative perceptions, is crucial for the successful implementation of human milk banks in Nigeria. Overcoming challenges, such as safety concerns and sociocultural influences, requires focused efforts from policymakers and healthcare institutions., (© 2024. The Author(s).)

Background: This article informs about the state of breastfeeding in Ukraine after more than 2 years of war. The article presents important information on breastfeeding data, the widespread implementation of the baby-friendly hospital initiative, human milk banks working in difficult situations, the first overestimation of breast milk substitute needs, the International Code, and the presence of donations reaching an overburdened health system. It covers the training of health care professionals as well as counseling in wartime. Conclusion: It is a testimony of important work done on different levels of the Ukrainian population as well as among the aid agencies present and the health system to protect and support breastfeeding for infants and mothers' health in a war situation. The acquired breastfeeding knowledge through BFHI training of health care professionals and the whole package of BFHI measures is important for ensuring the health and survival of children.

Background: Extremely preterm infants often receive donor milk. Hindmilk, which is released more than 3 minutes after letdown, could be advantageous due to its elevated levels of fat and calorie density. Donor milk expression habits may influence milk composition but have not yet been investigated. This study aims to assess the practices of milk donors and the feasibility of hindmilk expression. Methods: Active milk donors in Québec were questioned using an online survey about their milk expression habits and whether hindmilk donation would be acceptable to them. Answers were analyzed using mixed methods. Results: Of 181 donors, 126 fully completed the questionnaire (70%); 57% reported expressing donated milk between breastfeeds; 15% reported simultaneously breastfeeding while expressing donated milk from the other breast; 12% reported breastfeeding their baby on each breast, then expressing donated milk (hindmilk). The majority (66%) would be willing to change their habits most or all the time to provide hindmilk for preterm infants. The main themes invoked by respondents in open-ended answers were altruism and gratitude for being able to help others. However, 15% commented on the complexity of milk expression or that adding further complexity might discourage them from donating. Conclusions: Expression practices are variable, which may lead to variability in donor milk composition. Most donors would agree to change their expression habits in favor of giving hindmilk to help the most fragile infants. More information is needed on how changing recommendations for milk expression might impact the supply and composition of donor milk.

Background: Mother's milk provides optimal nutrition for infants. Donor human milk (DHM) is recommended for low birthweight infants when mother's milk is unavailable. Little is known about human milk (HM) donation practices in New Zealand (NZ), where few HM banks are available. This study aimed to investigate parents' and health professionals' (HP) experiences with formal and informal HM donation in NZ., Methods: Two electronic surveys were disseminated in 2022 to parents and HPs involved with HM donation in NZ. The surveys covered respondents' views and experiences with HM donation. HPs were also asked about HM donation practices in their workplace. Chi-squared and Fisher-Freeman-Halton exact tests were used for quantitative analysis and qualitative data were thematically analysed using inductive approach., Results: A total of 232 HP and 496 parents completed the surveys. Most parents either donated (52%) or sought DHM (26%) for their infant and most donations were informal, arranged between individuals (52%) or through hospital staff (22%). HP reported DHM was used in 86% of facilities, with only 20% of donations facilitated by HM banks. Almost half (48%) of HP stated they would like to use DHM in their workplace but access was limited. The most common screening processes undertaken by parents and HP before informal HM donation were lifestyle including smoking status, medication, drug and alcohol intake (44% and 36%, respectively) and serological screening such as CMV, HIV, Hepatitis C or B (30% and 39%, respectively). Pasteurisation of DHM obtained informally was not common. Most donors were satisfied with their HM donation experiences (informal and/or formal, 91%) and most respondents supported use of DHM in hospitals and community. Participants reported HM donation could be improved (e.g., better access) and identified potential benefits (e.g., species-specific nutrition) and risks (e.g., pathogens) for the infant. Potential benefits for the donor were also identified (e.g., altruism), but respondents acknowledged potential negative impacts (e.g., cost)., Conclusion: Informal HM donation in NZ is common. Most parents and HP support the use of DHM; however, improvements to current practices are needed to ensure safer and more equitable access to DHM., (© 2024. The Author(s).)

Clinicians caring for small, vulnerable newborns increasingly have access to specific nutritional information about human milk through point-of-care analyzers and labeled products. It is critical for clinicians to recognize that there is considerable variability in how human milk nutritional data are derived and reported, which impacts the interpretation of nutritional values, comparison of nutritional data between products, and ultimately the ability to deliver optimal nutritional care. This article distills key issues that will enable clinicians to interpret human milk nutritional labels/analysis more effectively, ultimately allowing them to make better decisions about dietary strategies. We aim to empower clinicians to ask questions about milk sampling techniques, reported nutrient values, analysis techniques, and milk bank pooling practices. This knowledge can put human milk nutrient values in context, improve clinical care, and help to drive more rigorous research for exploring the impact of human milk feeding on infant outcomes., (© 2024. The Author(s).)

Background: Bereaved mothers describe positive experiences donating breast milk and negative experiences when not informed of opportunities to donate. Predictors of whether mothers donate milk are unknown, impairing efforts to optimize support in completing donation. Objective: To define circumstances associated with completing mother's milk (MM) donation during bereavement. Methods: A retrospective cohort study included dyads of bereaved mothers and their deceased children if a child's death occurred on-site at a quaternary care children's hospital during 2016-2020, the child had documentation of MM availability, and age at death <24 months. The primary outcome was the completion of MM donation to the milk bank. Multivariate logistic regression measured associations between clinical variables and odds of completion. Results: Of 124 deceased children with documented MM exposure, 34 mothers (28%) of 35 of those children completed MM donation, donating a mean of 13.7 liters (SD 16.8). The child's race/ethnicity documented in the medical record was White for 25 (71%), Black/African American (AA) for 1 (3%), Asian for 1 (3%), and Hispanic/Latino for 8 (23%). Referenced to mothers of White children, being a mother of an AA [OR 0.05 (95% CI: 0.01-0.43)] or Asian [0.08 (0.01-0.75)] child was associated with lower odds of donation. Referenced to mothers delivering full term (≥37 weeks'), mothers delivering <34 weeks showed higher odds [5.0 (1.5-17.5)] of donation. Conclusion: Relatively few bereaved mothers of children with indicators of MM exposure completed donation. The results suggest an opportunity to ensure bereaved mothers are uniformly informed and supported in donating.

Human milk is considered the most suitable source of nutrition for infants. Donor human milk from human milk banks (HMB) is recommended as the best alternative for infants whose mothers' own milk is unavailable. Microbiological screening of milk donated to HMB is important to ensure the quality and safety of the pasteurised human milk. This article describes the microbiological status of human milk donated to the Regional Human Milk Bank in Toruń, Poland. Statistical data regarding the microbiological analysis of milk from 292 donors were collected in the years 2013-2021. Total of 538 milk samples were tested. Only in 6% of human milk samples the bacteria level was above the required standard and/or the milk had potentially pathogenic bacteria. The main core of donors' breastmilk bacteria represents the skin microbiota, and the composition of the microbiota is strictly related to the surrounding environment. The most abundant genera detected in milk samples were the Staphylococcus group. Prolonged hospitalisation of infants' mothers and/or offsprings is associated with potentially pathogenic bacteria colonization in milk. The use of the modern identification method MALDI-TOF resulted in more accurate results compared to the biochemical methods. Our analysis indicates that most of the tested milk samples (94%), both expressing at home and in hospital environments, meet the criteria for admission to the human milk bank. Effective techniques for identifying microorganisms ensure that donor milk from human milk banks meets the guidelines set for these units., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aims to examine and synthesise the views and experiences of women, donors, recipient mothers and healthcare professionals regarding human milk donation or sharing., Methods: The Joanna Briggs Institute (JBI) meta-aggregative approach to systematic reviews of qualitative studies was adopted. Six databases, MEDLINE, CINAHL, Embase, PsycINFO, Web of Science and Scopus were searched. English written qualitative studies from database inception to February 2024 were included. The JBI Critical Appraisal Checklist for Qualitative Research was used to appraise the collected research evidence., Results: A total of 629 papers were screened, and 41 studies were included in the review. Six key findings were synthesised. (i) Donors, recipients and their families all benefit from milk donation. (ii) Motivation to receive or donate breast milk. (iii) Awareness and participation are affected by formal vs. informal sharing, mothers' personal experiences and external factors. (iv) Concerns about disease transmission, jealousy, bonding and traits. (v) Challenges encountered by donors, recipient mothers, staff and milk banks (vi) Suggestions for promoting human milk donation., Discussion: Stakeholders of human milk donation, including donors, recipient mothers, healthcare professionals, and human milk bank representatives, face various physical, mental and practical challenges. Informal sharing complements formal donations and contributes to improved breastfeeding rates. Advocacy and education efforts are still needed to increase participation and safety levels. The major limitation of the study is the inadequate search on views of immediate family members., Competing Interests: Declaration of Competing Interest No conflicts of interest have been declared by the authors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Infants requiring neonatal care often face initial breastfeeding challenges, leading them to receive expressed breast milk from their mother or donor milk. While emphasizing the mother's own milk as the gold standard for infant nutrition, the utilization of donor milk stands as the preferred alternative over infant formula due to its numerous benefits. To facilitate the provision of donor milk to preterm and ill infants in neonatal units, the active participation of women willing to contribute their breast milk is crucial. This study aims to enhance the understanding of women's experiences in the donation process, thereby contributing to efforts aiming at alleviating the shortage of donated breast milk by improve the care and support for breast milk donors., Methods: This descriptive qualitative study took an inductive approach based on individual semi-structured interviews conducted during 2021 with 15 breast milk donors in Sweden. The data were analysed with thematic analysis., Results: Two themes were identified in the analysis: motivation to donate and challenges to overcome. Many of the women struggled to overcome the apparent challenges of not only starting the process of donating breast milk but also maintaining it. Despite the strain, they were motivated to donate their breast milk and seeking information by themselves to do something important for someone else. Only a few of the women talked about the financial benefits of donating breast milk; donating seemed to be mostly based on altruistic reasons., Conclusions: Despite the challenges posed by COVID-19 restrictions, time consumption, and the hard work of sterilizing pump utensils, women continued to donate their milk driven by altruism. To enhance donor support and increase milk donation, several improvements are suggested: providing comprehensive information and resources, simplifying the donation process, offering flexible scheduling, and recognizing donors' contributions., (© 2024. The Author(s).)

Background: Human milk banks are essential facilities to provide donated human milk (DHM) to preterm and term infants with health complications. Little is known regarding milk bank donors and how their characteristics may influence the particularities of the donation process. The present study aims to assess characteristics of donors and their newborns to identify associations with the amount of DHM and initiation and donation time, during the first and second year of the milk bank operation in Córdoba, Spain., Methods: This cross-sectional study was conducted in three periods: pre-opening of the milk bank (PRE) including all women who gave birth to a newborn between January - May 2017 and were hospital users; donors in the first year after the opening (Period 1 (P1): April 2019 - March 2020); and in the second year (P2: April 2020 - March 2021). For P1 and P2, DHM data were recorded. The relationships between donor and newborn characteristics and the donation process were examined using univariable and regression models., Results: From 391 women interviewed in the PRE period, 55 (14%) showed intention to donate. In P1 and P2, there were 51 and 25 human milk (HM) donors, respectively. Age, gestational age (GA) and parity were similar between periods. In P2, a higher proportion of donors had higher education (P1: 46%; P2: 70.8%, p = 0.045). Around 40% of donors in both periods were on maternity leave. In P1, donors who had low birth weight infants (< 2500 g) donated more HM than those with infants weighing ≥ 2500 g (p = 0.020). In P2, women whose GA was < 37 weeks donated a higher volume vs. those with ≥ 37 weeks (p = 0.002). Maternity leave was linked to a shorter initiation time for donations in both periods (P1: p = 0.002; P2: p < 0.001)., Conclusions: Data obtained from a Spanish human milk bank indicate that prematurity and low birth weight appear to influence the amounts of DHM. Employment status might be a decisive factor in initiating HM donation. Additional efforts are required to identify shared donor characteristics that influence the initiation and volume of donation., (© 2024. The Author(s).)

Introduction: Pasteurized human donor milk (DM) is frequently used for feeding preterm newborns and extrauterine growth-restricted (EUGR) infants. Most human milk banks performed a pasteurization of DM using the standard method of Holder pasteurization (HoP) which consists of heating milk at 62.5°C for 30 min. High hydrostatic pressure (HHP) processing was proposed to be an innovative nonthermal method to pasteurize DM. However, the effect of different modes of DM pasteurization on body growth, intestinal maturation, and microbiota has never been investigated in vivo during the lactation., Objectives: We aimed to study these effects in postnatally growth-restricted (PNGR) mice pups daily supplemented with HoP-DM or HHP-DM., Methods: PNGR was induced by increasing the number of pups per litter (15 pups/mother) at postnatal Day 4 (PND4). From PND8 to PND20, mice pups were supplemented with HoP-DM or HHP-DM. At PND21, the intestinal permeability was measured in vivo, the intestinal mucosal histology, gut microbiota, and short-chain fatty acids (SCFAs) level were analyzed., Results: HHP-DM pups displayed a significantly higher body weight gain than HoP-DM pups during lactation. At PND21, these two types of human milk supplementations did not differentially alter intestinal morphology and permeability, the gene-expression level of several mucosal intestinal markers, gut microbiota, and the caecal SCFAs level., Conclusion: Our data suggest that HHP could be an attractive alternative to HoP and that HHP-DM may ensure a better body growth of preterm and/or EUGR infants., (© 2024 The Author(s). Journal of Pediatric Gastroenterology and Nutrition published by Wiley Periodicals LLC on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

To identify the practices of promoting and supporting breastfeeding in maternity hospitals of three health regions of Paraná, Brazil. Cross-sectional study, with 1,270 puerperal women, between 2017 and 2018, using an instrument that included prenatal, delivery and postpartum care. The Chi-Square test was performed in the program XLSTAT, Version 2017. In prenatal care, 27.1% of pregnant women received guidance on breastfeeding and 44.5% prepared for breastfeeding. Skinto-skin contact occurred in 45.1%, with contact time less than 15 minutes (65.2%) and breastfeeding in the first half hour of life in 61.8%. In the joint housing, 88.6% received support and guidance and 93.9% practiced free demand. There were no guidelines to persist with lactation (47.3%), there was the use of cups or cups to offer breast milk (38.1%), and 47.1% donated breast milk. Factors that promote breastfeeding were identified, but not in an integral way. [ABSTRACT FROM AUTHOR]

Abstract Objectives: to verify the prevalence and factors associated with maternal insecurity in breastfeeding with lactating women treated at a milk bank. Methods: cross-sectional study with secondary record data from January 2017 to December 2018 at the Human Milk Bank of the University Hospital of the Federal University of Maranhão. Results: a total of 891 lactating women were analyzed, of which 23.4% had maternal insecurity, being the second most prevalent complication. Most were young adults, married (68%), with complete higher education (64.9%) and family income above five minimum wages (32.5%). Regarding the obstetric history, the highest frequency was ofprimigravida (63.7%o), primiparous (70%), who had had seven or more prenatal appointments (91 %) in private health services (76.5%) where most births also occurred (78.6%), with cesarean section being the most prevalent mode of delivery (86.5%), 47.2% reported never having received guidance on breastfeeding and 80.7% were breastfeeding for the first time. There was a statistically significant relationship (p-value < 0.05) of maternal insecurity with the place where the prenatal care was performed and the place and mode of delivery. Conclusion: maternal insecurity was the second most prevalent breast complication among lactating women in the service. It stands out the need for adequate guidance and counseling on the subject, especially during prenatal care, contributing to avoid early weaning

Copyright of Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS) is the property of Universidade Federal do Triangulo Mineiro, Instituto de Ciencias da Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pasteurized donor human milk provides a safe and desirable alternative when a parent's own milk is insufficient or unavailable. Currently, the demand for donor human milk exceeds the available supply. Little is known about the beliefs breastfeeding individuals have about milk bank donation., Research Aims: The aims of this exploratory study were to (a) provide a preliminary estimate of how well intention can be predicted, and to suggest which of the global constructs of the Reasoned Action Approach has the most influence on intention; and (b) identify the salient, top-of-the-mind beliefs underlying the intention to donate some of the milk an individual is currently producing to a milk bank., Methods: An exploratory, cross-sectional study design, based on the Reasoned Action Approach, was used to measure the theory's global constructs and elicit beliefs underlying the intention to donate milk of lactating individuals ( N  = 118) living in Indiana, Illinois, Missouri, and Kentucky. Thematic and frequency analyses and multiple regression were performed., Results: Quantitative analyses found that injunctive norm and the autonomy component of perceived behavioral control were independently associated with intention. Qualitative analyses identified the advantages (e.g., help and save babies, won't waste milk), referents who support (e.g., husband, family), and facilitators (e.g., having a convenient, close location, having more knowledge and information) of donating milk., Conclusions: This research provides insight into how milk banks might recruit and retain donors. Additional quantitative research with a larger sample is necessary to confirm the preliminary findings of this study., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. All research was conducted prior to the first author’s current affiliation. Views represented herein do not represent the Indiana Department of Health.

Professor Joao Aprigio Guerra de Almeida graduated in Food Engineering (UFV-1981) with a Master in Microbiology (UFV-1986) and a doctorate in Women's and Children's Health (Fiocruz/IFF, 1998) He is founder and coordinator of the Brazilian Human Milk Banks Network (Ministry of Health-Brasil/Oswaldo Cruz Foundation-Fiocruz, 1987 to 2024); Head of the National Reference Center for Human Milk Banks at the National Institute of Women, Children and Adolescent Health Fernandes Figueira-IFF (Fiocruz/IFF, 1987 to 2024); Executive Secretary of the Ibero-American Human Milk Banks Network Program (Ibero-American General Secretariat-SEGIB/Brazilian Cooperation Agency-ABC/MS-FIOCRUZ, 2008 to 2020); Coordinator of International Technical Cooperation in Human Milk Banks ABC/Fiocruz/MS (2005 to 2024); and Coordinator of the Human Milk Banks Network of the Community of Portuguese Speaking Countries - CPLP (2017 to 2024). He has been recognized with the Sasakawa Health Prize (World Health Organization [WHO], 2001); as Officer of the Order of Rio Branco (Presidency of the Federative Republic of Brazil, 2001); with Global Health Challenges and Responses of the South in Time of Crisis (WHO, 2009); as Commendator of the Order of Rio Branco-Ministry of Foreign Affairs/Presidency of the Federative Republic of Brazil (2018); and Dr LEE Jong-wook Memorial Prize for Public Health (WHO, 2020). His areas of activity include Public Health, breastfeeding, Human Milk Banks, Public Management, and International Technical Cooperation., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The author disclosed no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author was a member of the Editorial Advisory Board of the Journal of Human Lactation at the time of submission of this article.

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The aim of the study was to obtain information on the knowledge, opinions and attitudes of Polish women in terms of functioning of human milk banks, as well as the possibility to be a donor. Specific objectives included consideration of responses in the sociodemographic aspect and identification of factors influencing donation decisions. Material and methods: A cross-sectional survey was conducted, obtaining 871 responses. Women were asked to provide basic sociodemographic data, information related to pregnancy and lactation. Knowledge and opinion about breast milk banks as well as the impact of various factors on a potential donation decision were investigated. Results: Of all women participating in the study, 604 (69%) were aware of the breast milk banks existence. 69% of respondents indicated the Internet, 10% -- a nurse or midwife, while only 4% -- a doctor as source of knowledge about human breast milk donation. Among women who had children (n = 453), only 9 (2%) donated breast milk in the past. The indicated reasons for not donating were no milk excess (38%), insufficient knowledge about the procedure or unawareness of its existence (33% and 25%, respectively), long distance to affiliated facility (17%). Conclusions: The awareness of breast milk banks existence, possibilities and terms of donation in the studied group is not satisfactory. Widely sharing reliable information on banking and promoting the idea of donating human breast milk in society can lead to impressive results. There is a need for further development of human breast milk banks and continuous improvement of their availability in Poland. [ABSTRACT FROM AUTHOR]

Abstract Objective: to analyze the understanding of mothers about the donation of human milk. Methods: a qualitative and quantitative study with 13 potential milk donors who answered a sociodemographic and obstetric background questionnaire, as well as a semi-structured interview guide on milk donation. Mothers were approached in the hospital environment, after delivery and the visit of the milk bank. Data were analyzed in Statistical Package for Social Sciences 20.0 and NVivo 11 Starter. Results: the mean age was 24.62 ± 3.95 years; 84.6% had more than eleven years of formal education; 38.5% declared themselves housewives; 46.2% were in a stable union and 76.9% had an income of up to two minimum wages. Most of the mothers (69.2%) experienced previous pregnancy; 76.9% had 6 or more prenatal consultations and 62.5% had previously breastfed. The motivating factors of the donation were altruism; empathy with other mothers; recognition of the primacy of breast milk; the child's understanding of breast milk need; excess milk production and family support. Unawareness of the process, limited time available, and lack of transportation and collection points can make donation difficult. Conclusions: there was a desire for information and support for breastfeeding and donation, which made the donation act complex and distant from reality.

Introduction: Not all mothers can provide sufficient milk, and infants admitted to a neonatal ward are less likely to be exclusively breastfed. Current recommendations are for the use of mother’s own milk (MOM), and pasteurized donor human milk (PDHM) is the next best choice. The present article was prepared as a tool to study the optimal organization of Human milk banks (HMB) and to contribute to the diffusion of the culture and promotion of breastfeeding and summarize current best practices for the handling of PDHM. Materials and Methods: PubMed, Embase and Cochrane were searched using the search term combination “human milk banks” OR “pasteurized donor human milk”. Results: HMB are responsible for human milk (HM) promotion, collection, processing, protection, quality control, distribution and support. The quality of expressed HM is the result of adequate hygienic-sanitary conditions, from expression to administration, and the evaluation of nutritional, immunological, chemical, and microbiological characteristics. It is essential a multidisciplinary team to support an HMB. Conclusion: In settings where donor HM supplies are limited, prioritization of infants by medical status is key. The manner in how investments in human milk feeding are applied should be targeted. The purchase cost of PDHM should be compared with the purchase costs of other nutrition interventions routinely used in care for critically ill neonates.

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low-birth-weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in-depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics., (© 2024 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

The correct initial colonization and establishment of the gut microbiota during the early stages of life is a key step, with long-lasting consequences throughout the entire lifespan of the individual. This process is affected by several perinatal factors; among them, feeding mode is known to have a critical role. Breastfeeding is the optimal nutrition for neonates; however, it is not always possible, especially in cases of prematurity or early pathology. In such cases, most commonly babies are fed with infant formulas in spite of the official nutritional and health international organizations' recommendation on the use of donated human milk through milk banks for these cases. However, donated human milk still does not totally match maternal milk in terms of infant growth and gut microbiota development. The present review summarizes the practices of milk banks and hospitals regarding donated human milk, its safety and quality, and the health outcomes in infants fed with donated human milk. Additionally, we explore different alternatives to customize pasteurized donated human milk with the aim of finding the perfect match between each baby and banked milk for promoting the establishment of a beneficial gut microbiota from the early stages of life.

Human milk provides essential nutrition for infants and holds many health benefits for infants and mothers. When a mother's own milk is not available for her infant, the World Health Organization recommends feeding donor human milk (DHM) from a human milk banking facility. DHM is human milk produced, collected then donated to a human milk bank (HMB). HMBs serve many vital functions, including screening donor mothers, then collecting, processing, storing, and allocating DHM to recipients. The first HMB opened in 1909, and today there are more than 700 HMBs globally. Unfortunately, HMB facilities are not present in all locales, with notable gaps in South Asia and Africa. Additionally, there are no global standards to guide HMB operational procedures. Even though most HMBs attempt to employ quality control systems to provide safe DHM, differences in community needs, resource availability, and a range of methods and policies to execute processes result in significant variations in DHM quality and HMB operations. Robust and collaborative systems that ensure safe and equitable access to DHM are needed. In this paper, we present a global snapshot of current human milk banking practices; review an interdisciplinary framework to guide and support HMB activities as an integrated part of health and newborn care systems; discuss factors that contribute to HMB sustainability; outline barriers to scaling HMBs worldwide; and highlight knowledge, policy, and research gaps. Developing global HMB guidance and rigorous, adaptable standards would strengthen efforts to improve newborn health., (© 2023 PATH. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: The microbiological safety of donor milk (DM) is commonly ensured by Holder pasteurization (HoP, 62.5 °C for 30 min) in human milk banks despite its detrimental effects on bioactive factors. We compared the antimicrobial properties of DM after Holder pasteurization treatment or High Hydrostatic Pressure processing (HHP, 350 MPa at 38 °C), a non-thermal substitute for DM sterilization., Methods: We assessed lactoferrin and lysozyme concentrations in raw, HHP- and HoP-treated pools of DM (n = 8). The impact of both treatments was evaluated on the growth of Escherichia coli and Group B Streptococcus in comparison with control media (n = 4). We also addressed the effect of storage of HHP treated DM over a 6-month period (n = 15)., Results: HHP milk demonstrated similar concentrations of lactoferrin compared with raw milk, while it was significantly decreased by HoP. Lysozyme concentrations remained stable regardless of the condition. Although a bacteriostatic effect was observed against Escherichia coli at early timepoints, a sharp bactericidal effect was observed against Group B Streptococcus. Unlike HoP, these results were significant for HHP compared to controls. Stored DM was well and safely preserved by HHP., Conclusion: Our study demonstrates that this alternative sterilization method shows promise for use with DM in human milk banks., Impact: Antimicrobial activity of donor milk after High Hydrostatic Pressure treatment has not been clearly evaluated. Donor milk lactoferrin is better preserved by High Hydrostatic Pressure than conventional Holder pasteurization, while lysozyme concentration is not affected by either treatment. As with Holder pasteurization, High Hydrostatic Pressure preserves donor milk bacteriostatic activity against E. coli in addition to bactericidal activity against Group B Streptococcus. Donor milk treated by High Hydrostatic Pressure can be stored safely for 6 months., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)