Human milk banks may help save vulnerable babies

Njabulo’s mother knew breast milk would be the best food for her baby, so when her son was born, she tried to breastfeed him. But Njabulo’s mother was HIV-positive, and a few weeks after her son’s birth, she became too ill to continue breastfeeding. When Njabulo was just two months old, his mother died.

With his mother gone, Njabulo had no access to the breast milk that could safely provide all the energy, nutrients, and fluids he would need for the first six months of his life, as well as antibodies to keep him free from illness. When he arrived at the iThemba Lethu transition home for HIV-exposed infants in the KwaZulu-Natal province of South Africa, he was severely underweight and suffering from frequent diarrhea and a severe skin rash.

Njabulo’s condition was serious; he was in desperate need of safe nutrition. Luckily, the transition home had a human milk bank.

Donated milk for at-risk babies

Human milk banks, which rely on donated mothers’ milk, play an important part in ensuring that safe breast milk is available to babies whose mothers are unable to provide it. The banks are even more crucial for vulnerable babies like Njabulo—those who are pre-term, low birth weight, severely malnourished, born to HIV-positive mothers, or orphaned. These babies are at high risk of illness and death.

Human milk banks had long been an effective strategy for providing donor milk to babies. Then, in the early 1980s, HIV was discovered in breast milk. The finding put the milk banking approach in some doubt, although the World Health Organization (WHO) continued to consider milk banking a “first alternative” for babies who needed breast milk. In 2008, WHO called for World Health Assembly member nations to promote the safe use of donor milk delivered through human milk banks for vulnerable babies.

Now, human milk banks like the one at iThemba Lethu pasteurize donated milk to help ensure its safety, and workers in public health increasingly recognize the banks’ potential to help infants survive and thrive.

A growing interest

Responding to requests from health care managers, we have been assessing model milk-banking systems in South Africa, where an estimated 19 private and public milk banks are operating, as well as in Brazil, which is home to the largest network of human milk banks in the world. The Brazilian National Network of Human Milk Banks supports human milk banks as one element of  their national strategy for promoting breastfeeding. The country’s nearly 200 banks collect as many as 140,000 liters of donated milk each year.

We’re also looking at developing a low-cost system to manage the safety of human milk banking by using cell phones to record and transmit pasteurization temperatures and a simplified assay to test for bacterial contamination in milk. Such a low-tech system could could then be used in resource-limited areas.

A fresh start at life

In South Africa, interest in human milk banking continues to grow. For babies like Njabulo, incorporating donated milk into feeding strategies may help encourage growth, development, and even survival.

Njabulo's story is a happy one. As he began to receive donated human milk, his health improved dramatically. His diarrhea stopped. His rash disappeared. He gained weight. By the time he was three months old, Njabulo was a growing, thriving baby. All babies deserve this opportunity.

Photo: Wendy Stone.