by Dr Natalie Shenker, BM BCh (Oxon), MSc, PhD Epigenetics and Breast Cancer (Imperial)
Maternal breastmilk is the best nutrition for a baby who is ill, or born prematurely. However, mothers of sick children can often struggle to express any or enough of their own milk in the first few days after birth. In this situation, donated breastmilk is recommended by the WHO1, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the American Association of Pediatrics as the best alternative to maternal milk. It is the role of a milk bank to recruit and screen donors, check and process the milk, and store and distribute it to neonatal units safely.
Milk banks have existed in the UK for over 80 years. Before the 1980s there was a milk bank in almost ever maternity unit in the country. The combined effects of HIV, a greater emphasis on screening and safety incurring larger costs, and the increased use of formula by medical professionals led to the closure of the majority of milk banks. Now there are just 13 in England, none in Wales, a single milk bank in Northern Ireland which supplies most of the island of Ireland, and a National Service in Scotland.
Even after donated breastmilk is pasteurised (heat-treated for 30 mins at 62.5°C), 60% of immunoglobulins, and other components that help protect premature babies from infection and are not present in formula, are preserved. Work is ongoing to understand how heat treatment can affect other components, and whether other approaches to processing the milk may be better.
The WHO recommendation described above is relevant for healthcare settings where safe and affordable milk-banking facilities are available or can be set up. It does not address sick low birth weight infants or infants with birth weight less than 1.0 kg.
The current main recipients of donor breastmilk are preterm babies and babies recovering from gut surgery. Donor breastmilk may have a protective role against necrotising enterocolitis (NEC), which mainly affects premature babies2. The preterm immature gut is able to digest and absorb breastmilk more easily than formula milk. Other situations arise where donor breastmilk might be the preferred option for the parents when medical reasons prevent maternal breastmilk feeding (eg. maternal chemotherapy, essential maternal drugs contraindicated in breastfeeding). Currently donor milk quantities in the UK do not permit the regular use of donor milk in these circumstances and a case-by-case approach is necessary. The charity UKAMB is working towards the formation of a national donor breastmilk service to supply infants throughout the UK according to priority of need, rather than geographic proximity to a Milk Bank.
As the recipients of donor milk are often very premature or very sick babies, they are likely to have a compromised immune system, immature or damaged livers and kidneys or be more likely to be affected by contaminants in breastmilk. Milk banks have a duty to provide the safest breastmilk possible. For this reason they endeavour to screen out mothers whose milk may contain any metabolites from the breakdown of medications and drugs, (including nicotine, substances of abuse and alcohol) and other possible contaminants.
In all instances it is well recognized that although a mother may not be able to donate her breastmilk to a milk bank, that does not mean that her milk is unsafe for her own baby or that it would be better to use an artificial milk/formula. There are a very few situations where a mother may be advised by her GP or specialist not to breastfeed– these include cancer treatments, a few long term medications and if she has HIV. Courses of medications are sometimes given as a reason to temporarily stop breastfeeding but in most cases it is safe to continue to do so (see our webpages on ‘Prescribing Information‘ to check for specialist information on the safety of drugs in Breastmilk).
All potential milk donors must have up to date screening for the following blood borne viruses and cannot donate if they test positive (see NICE Guideline CG93 below):
- HIV 1 or 2
- Hepatitis B or C
- HTLV I or II
With thanks to both Dr Shenker and Gillian Weaver for their contributions to this website. They are the co-founders of the Hearts Milk Bank, the UK’s newest milk bank, which will provide donor milk across London and the South East and support programmes of research into breast cancer risk, infant nutrition and the optimal processing and use of donated breastmilk.
UKAMB: Information for Professionals Information about the latest protocols, evidence underpinning donor milk use and milk bank operations.
United Kingdom Association for Milk Banking (UKAMB) Charity that supports human milk banking in the UK, good practice and guideline development. The website includes a map of UK Donor Milk Banks.
One Milk Bank for Scotland Milk bank hosted by NHS Greater Glasgow and Clyde covering the whole of Scotland.
The Western Trust Milk Bank Issues donor milk to units around Ireland, operating in accordance with UK NICE guidance.
Hearts Milk Bank The UK’s newest milk bank, which will provide donor milk across London and the South East and support a new programme of breast cancer research.
UKAMB: Breastmilk Sharing Statement Advice on safe milk donation.
NICE Guidance CG93: Donor milk banks – Service Operation (2010) Includes guidance on screening and selecting donors, expressing and handling breastmilk at home for donation.
- WHO: Donor Human Milk for Low Birth Weight Infants Updated January 2017
- Boyd C, Quigley M, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2007;92(3):F169-F175.