Human Milk Bank

DR.SANDHYA KHADSE

PROFESSOR AND HODDEPARTMENT OF PAEDIATRICS

BJMC AND SASSOON GENERAL HOSPITAL

PUNE

Dr. Sandhya Khadse Introduction as Speaker Recipient of : •Six Gold Medals in University Examination (1986)•James Flett Endowment Award (1995)•Bibi Sunder Kaur IAP Fellowship (1996)•First Prize for Best Poster PEDICON (1997)•Gold Medal for Best Paper Presentation ACODD 2001•Patented Pediatrician Award Maha Pedicon 2003•FIAP Award 2005 for Outstanding Contribution in Paediatrics•Maha Pedicon 2006 Best Research Paper Award•Chief Officer Child Health Monitoring Committee, Maharashtra State. •Delivered around 150 guest lecturers in various National & International Conferences •50 publications in various National & International journals •Visiting professor at John Hopkins School of medicines •Nutrition Expert & Board of study member at Footprints Academy Preschool daycare Center at Florida USA.•Academy advisor to the U.S. Fulbright programme & resource person for United States India Educational Foundation. (USIEF) •Executive Committee member of CANCL Group & IACP. •Technical Expert for Human Milk Bank Project.

Background info

Page 3

Brief description

How did your human milk bank (HMB) began? When?

It was started on 18th feb 2006 at Grant medical college and JJ group of hospitals, Mumbai

Who provided initial funding? How are ongoing operations funded? Integrated into government services?

Rotary club of Nariman point , Mumbai and ongoing operations funded by government.

Who regulates /oversees HMB in your country/region (if any)?

Individual hospitals where they are operational.

How many HMBs are part of your system? Where are they?

5 in Mumbai- JJ hospital , CAMA hospital , SION hospital , KEM hospital and RGMC Thane and chatrapati shivaji hospital , Talwa -1 in Surat -1 in Hyderabad -1 in Goa

Is there a central HMB that processes milk and distributes or many HMBs that process milk and distribute? (Centralized vs de-centralized)

NO

How many NICU/Neonatal wards/community homes does each bank serve? Are they collocated?

Each milk bank serves individual NICU and neonatal wards of the respective institute.

How many babies does your facility/system serve annually?

Approximately 600-700 babies.

How many liters/year does your facility/system process annually?

12000-15000 ml.

How many donor mothers initiate donation to your facility/system annually?

1200-1500 mothers per year are recruited.

4

ProcessBrief description of processes

Staffing -staff sister of NICU-3 resident doctors by rotation.-2 technicians by rotation.-1 senior pediatrician.

Donor recruitment -PNC ward mothers -Mothers coming to follow up in neonatal clinics.

Donor screening -Routine screening for - HbSAg - HIV -VDRL

Recipient eligibility and selection

-Physically fit mothers with BMI around 18.5-Hb more than 10gm%-Negative for HbSAg , HIV , VDRL.-CONSENT OF THE MOTHER.

Handling and storage of donor milk (from donation to feeding)

-Collected by manual expression or using electronic milk pumps.-The milk is stored in the container , tightly sealed & refrigerated according to its date of

collection.Breast Milk is safe for four to six hrs at room temperature i.e.- 15 to 25 deg centigrade.Fresh milk can be stored in the refrigerator for five to seven days and in the deep freezer at -

20 deg centigrade for six months.Thawed refrigerated milk is safe for 24 hours.Heat treatment & microwaving is NOT recommended.

6

ProcessBrief description of process

Transport of milk -Done using vaccine carriers

Pasteurization Pasteurization done at 60 degrees.

Tracking and record keeping

Separate registers for the same and also for feedback from mothers are maintained.

Assessing milk quality and safety (ie. microbiology assays)

Regular cultures are done of each and every sample collected.

Quality assurance Accredited microbiology laboratory and ISO-Certified NICU present.

Equipment/LocationBrief description of process

What is used/how many? • Pasteurizer-1• Freezers (lockable?)-1• Refrigerators-1

Additional HMB equipment requirements?

• Ex. lockable room-yes• Computers-yes• Other

Referral/feeder/depot facilities?

• How many?• Equipment requirements? No

Neonatal ward equipment requirements?

• System for tracking usage? - Record maintained in registers and computers.

• Freezer?-yes

Other? • Breast milk pumps -electronic-4 -manual-20Milk collection stainless steel containers.

Organizational Successes

Page 9

Brief description of top 3-5 successes

Policy Helped in promotion of exclusive breast feeding.

Operational -satisfied mother-weight gain of the baby.-increased confidence and morale of HIV positive women who like to feed

their babies on human breast milk.-Baby victim of 26/11 bomb blast was fed on milk from HMB for 3 months.

Technology -To screen mothers for HCV infection.

10

Publication: The Times Of India Mumbai;

Date: Jan 22, 2009;

Section: Times City;

Page: 3;

Organizational Challenges

Page 11

Brief description of top 3-5 challenges

Policy No administrative or central government support.Lack of fundingNot included in PIP of NRHM inspite of giving the proposal.HMB not in the priority list in public health domain or MCH progamme.

Operational A ll staff work with motivation and personal interest and passion No designated staff separately for the purpose.

Technology Absolutely no wastageOn day today basis almost 100 percent usage is present.

- Extensive Training, motivation, commitment…

•Mothers to be motivated for milk donation

Attendants and sweepers of PNC, NICU & Pediatric wards being trained

Regular Parents Meeting

13

Milk bank in every first referral hospital where department of Paediatrics and Microbiology works…

THANK YOU