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:
[email protected]
Tel.: +39 3485659614
TWENTY- SEVEN MILK BANKS IN 2012
PIEMONTE
Torino
Prof. Enrico Bertino,
Head Nurse Elisabetta Punziano
Moncalieri
Dr. Antonio Marra,
Ms Patrizia Soriani
TRENTINO ALTO ADIGE
Trento
Dr. Giuseppe De Nisi, Head Nurse Maria Luisa Zattoni
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
ABRUZZO
LOMBARDIA
Milano
TOSCANA
Arezzo
Dr. Pier Giorgo D’Ascola, 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
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.: 02 2893631
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 23 other NICUs of the same region.
How many babies does your facility/system
serve annually?
All the babies with a BW < 1800 g admitted to the NICU (app. 90), plus the infants < 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
Page 3
external mothers of term infants).
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 Medicine’s,
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 Medicine’s,
September 2010; 23(S2): 1-20)
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)
Equipment/Location
Brief description of process
What is used/how many?
• Pasteurizer: 1 Sterifeed
• Freezers: 3 freezers at – 20°C
• Refrigerators: 2 refrigerators
Additional HMB equipment • Computer : 1 devoted to the bank
• Other : Milk Scan Analyzer (Foss Electric); osmometer (De
requirements?
Mori)
Referral/feeder/depot
facilities?
• How many?
• Equipment requirements?
Neonatal ward equipment
requirements?
• System for tracking usage?
• Freezer?
Other?
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 mother’s 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.
Page 7
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.
Page 8