Mothers’ Milk Bank

Lactoferrin is an iron-binding glycoprotein in human milk (HM) that reduces the risk of neonatal sepsis. Data from low- and middle-income countries regarding the determinants of HM lactoferrin concentration is limited. Our objectives were to assess how HM lactoferrin concentrations change over time and identify factors associated with lactoferrin concentration. From a pregnancy cohort in Sylhet, Bangladesh, we enrolled 99 women to join the lactation sub-cohort and provide HM samples at a median of 50 (T1) and 146 (T2) days postpartum. We measured HM lactoferrin concentrations with meso-scale discovery and examined associations with predictors including indices of maternal nutritional status [body mass index (BMI), mid-upper arm circumference (MUAC), hemoglobin], depression scores, infant gestational age, and birthweight-for-gestational age z-score. HM lactoferrin concentration increased by 21% from T1 to T2. Higher gestational age at birth was associated with lower HM lactoferrin concentration at T1. Higher maternal MUAC was associated with higher HM lactoferrin concentration at T2. In rural Bangladeshi women, HM lactoferrin concentration increased during the postpartum period. Higher lactoferrin was associated with earlier gestational age at delivery and better maternal nutritional status. Interventions to improve maternal nutritional status might also increase HM lactoferrin concentration and ultimately, benefit child outcomes.

ABSTRACTProtein and fat concentrations in donor human milk (DHM) can vary twofold to threefold and are influenced by the number of unique donors per pool. The aim of this study was to broadly characterize how the number of donors (2–10) randomly combined into a pool during milk bank processing influenced the variability of macronutrients, vitamins, minerals, and bioactive factors in DHM. The minimum number of donors required for 80% of the pools to meet pre‐defined targets for true protein, fat, and disialyllacto‐N‐tetraose (DSLNT) was also evaluated. Monte Carlo simulation was used to create models that accounted for donor lifetime donation volume and milk bank production constraints. Variability in nutrients was quantified as a Nutrient Inequality Index (NII) which was computed as the ratio of the 90th percentile to the 10th percentile for each simulation. Random multi‐donor pooling of 2–10 donors produced lower variability in DHM macronutrients than most vitamins and minerals. A priori targets of 0.9 g/dL of true protein, 3.5 g/dL of fat, and 210 µg/L of DSLNT could not be achieved with any random pooling scenario. The NII for lactose stabilized at less than 1.1 when there were 3+ donors per pool, while the NII for fat and true protein stabilized at less than 1.3 when there were 5+ donors per pool. The NII exceeded 1.5, even at 10 donors per pool, for several micronutrients including zinc, copper, sodium, iron, biotin, riboflavin, B6, B12, and pantothenic acid.

Guatemala has one of the highest rates of maternal mortality in Central America. A total of 60% of births in Guatemala are attended by traditional Mayan birth attendants, or comadronas. Their prevalence in these communities makes them a valuable resource to bridge home births with safe prenatal care. The objective of this study was to evaluate a low-cost prenatal care training program for Guatemalan comadronas with the goal of improving maternal health outcomes in the region. In this retrospective longitudinal cohort study, we examined the knowledge retention of comadronas enrolled in a 12-month prenatal care training program known as the School of PowHER (SOP). Recruited from the Lake Atitlán region of Guatemala by Saving Mothers, 501(c)(3) and the Guatemalan Ministry of Health, comadronas participated in a four-month didactic curriculum followed by a nine-month clinical curriculum. Pre- and post-tests were administered to assess learning outcomes over the study's duration (2014-2022), and test results were evaluated to assess the effectiveness of the SOP. A total of 123 women were recruited and enrolled in all eight graduating classes of the SOP from 2014, 2016-2019, and 2021-2022. An average, statistically significant improvement in didactic and clinical pre- and post-test scores was found across all years analyzed. The SOP is a low-cost, culturally appropriate, community-based model that empowers comadronas through knowledge and skill acquisition to improve local maternal health outcomes. This program proves effective at not only teaching comadronas prenatal health information and clinical skills, but also at promoting long-term retention of these skills.

This paper demonstrates a teacher-as-researcher intervention study of Student Self-Assessment, utilizing GeoGebra activities on the topic of relationships of geometric figures. The teacher researcher studied students’ achievements and self-directed learning by including Student Self-Assessment (SSA) and by teaching procedural knowledge and conceptual knowledge using eleven GeoGebra-based tasks at the same time. The data were collected via questionnaire, interview, as well as two tests which were given after task 6 and task 11 were completed. The teacher researcher oversaw the progress of the 24 Thai male and female junior high mathematics students (13-14 years old), and offered prompt guidance and support using normal classroom techniques.The findings indicated that the utilization of SSA and GeoGebra had a positive impact on these students' academic performance and their ability to take charge of their learning in mathematics classes. Specifically, the intervention led to 1) improved communication between student and teacher; 2) improved students’ understanding of what they needed to learn; 3) improved students’ confidence to ask for help from the teacher; 4) promoted student achievement; and 5) promoted self-directed learning in mathematics lessons.

Antibiotics are an essential tool for perinatal care. While antibiotics can play a life-saving role for both parents and infants, they also cause collateral damage to the beneficial bacteria that make up the host gut microbiota. This is especially true for infants, whose developing gut microbiota is uniquely sensitive to antibiotic perturbation. Emerging evidence suggests that disruption of these bacterial populations during this crucial developmental window can have long-term effects on infant health and development. Although most current studies have focused on microbial disruptions caused by direct antibiotic administration to infants or prenatal exposure to antibiotics administered to the mother, little is known about whether antibiotics in human milk may pose similar risks to the infant. This review surveys current data on antibiotic transfer during lactation and highlights new methodologies to assess drug transfer in human milk. Finally, we provide recommendations for future work to ensure antibiotic use in lactating parents is safe and effective for both parents and infants.

AimsThe use of donor human milk (DHM) for preterm infants, where the mother’s milk is not available, has benefits such as protecting infants against the potentially fatal condition of necrotising enterocolitis, and when used optimally, supporting mothers to establish breastfeeding. Understanding the relationship between clinical choices for DHM provision and the resulting demand is important. For policymakers, it allows for informed decision making around the provision of DHM based on cost-benefit analyses. For milk banks, it helps plan for donor recruitment and supply-side collections. Herein we describe two studies that present the current and anticipated use within UK hospital neonatal units, and the development of a framework to estimate DHM demand for infants born preterm in England and Wales.MethodsThis work had three streams of work: i) auditing existing DHM use guidelines within hospitals in England and Wales; ii) an online survey administered using SmartSurvey between February and March 2022 completed by the clinical lead for enteral feeding; iii) a framework to estimate overall demand for DHM in England and Wales. The framework considered various sources of secondary data (e.g., NHS maternity statistics and ONS data), different feeding protocols and options for DHM provision, and was implemented using a spreadsheet model.ResultsEnteral feeding guidelines were received from hospital neonatal units across England and Wales, suggesting marked diversity in DHM implementation and usage. Surveys were completed by 106 units (18 Level 1 (17.0%), 47 Level 2 (44.3%), 41 Level 3 (38.7%); cot numbers 4-56; 55.4% of all UK units). All thirteen Operational Delivery Networks were represented. Of 106 units, only four did not use DHM at all, and a further five did if the infant was transferred while on DHM feeds. Responses from 90 units (84.9%) indicated DHM was sometimes (n=35) or always (n=55) supportive of maternal breastfeeding, whereas three responses stated it was rarely supportive. Thirty-seven units (34.9%) stated their use would increase in the next 2 years, 33 (31.1%) said it would stay the same, and four said it would decrease (3.8%), with 28 (26.4%) unsure. The framework model (figure 1) estimates the overall demand for DHM in England and Wales and local level demand for NHS Trusts in England. By adopting conservative assumptions for feeds where there is complete or partial shortfall in maternal milk supply for infants born up to 34 weeks gestation for 5-6 days median average, with a further 2-6% unable to supply any maternal milk, the model estimates hospital usage to be between 24,500-31,000 litres (figure 2), approximately triple the current provision. 770 Figure 1 770 Figure 2ConclusionBy identifying the potential future regional and overall national demand for DHM, this study informs decisions on developing milk bank infrastructure in the UK. In the context of decision-making regarding future service design through the BAPM Framework for Practice on the use of donor human milk this year, this is timely research to inform the development of cost-effective and efficient milk banking services that can ensure equity of access nationally.

Abstract Background: Mother’s own milk (MOM) is the best nutrition for preterm infants; however, milk from cytomegalovirus (CMV)-seropositive mothers may cause the transmission of the virus to the infants. As extremely preterm infants are at a risk of developing serious conditions due to CMV infection, even MOM is sometimes pasteurized. Previously, we demonstrated that microwave heating of 50 mL formula milk containing CMV at 500 W for 40s prevented CMV infection in living cells. However, we do not know if this is the case with reactivated CMV in human milk (HM). Therefore, we investigated if microwave heating of HM would be effective in preventing CMV infection in living cells.Methods: Twenty-three CMV-IgG-positive and four CMV-IgG-negative mothers who donated HM to the human milk bank during 6 to 16 weeks postpartum were enrolled. The HM was treated with microwave at 500 W. HFL-III cells were seeded in culture dishes. Aliquots of HM samples subjected to microwave was inoculated onto susceptible cell monolayers. Infectious vial titer was measured by the median tissue culture infectious Dose (TCID50) assay. Results: The TCID50 assay was decreased in five out of eight 100-mL samples after microwave at 200W for 60 s. The CMV plaque assay was negative in three, decreased in eight, and no change in six 100-mL samples, and negative in four and decreased in eight 50-mL samples.Conclusions: Microwave heating of HM at low settings could decrease CMV transmission through HM, however, to obtain entire prevention is difficult when loss of bioactive properties is considered.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies have been detected in human milk up to 6 weeks post-coronavirus disease 2019 (COVID-19) vaccination. We evaluated SARS-CoV-2-specific antibodies, neutralization activity, effect of pasteurization, and persistence through 6 months after vaccination. This prospective longitudinal study enrolled 30 pregnant or lactating women. SARS-CoV-2 antibodies and neutralization capacity were analyzed using an enzyme-linked immunosorbent assay compared at prevaccination and 1, 3, and 6 months postvaccination, and through Holder pasteurization. Human milk SARS-CoV-2-specific IgG levels peaked at 1 month postvaccination and persisted above prevaccination levels for at least 6 months (P = .005). SARS-CoV-2-specific IgA was detected at 1 and 3 months (both P < .001) but waned by 6 months compared with baseline (P = .07). Milk SARS-CoV-2-specific IgG and IgA correlated with serum IgG at the same time point (R2 = 0.37, P < .001 and R2 = 0.19, P < .001). Neutralization activity was seen in 83.3%, 70.4%, and 25.0% of milk samples at 1, 3, and 6 months postvaccination. Neutralization most strongly correlated with SARS-CoV-2-specific IgG (R2 = 0.57, P < .001). Pre- and postpasteurization samples showed similar IgG (0.84 vs 1.07, P = .36) and neutralizing activity (57.7% vs 58.7% inhibition, P = .27), but lower IgM and IgA levels postpasteurization (0.09 vs 0.06, P = .004 and 0.21 vs 0.18, P = .043). The data suggest that human milk SARS-CoV-2-specific antibodies may be available to milk-fed infants for up to 6 months. In addition, donor milk from vaccinated mothers retain IgG and neutralizing activity.