Breastfeeding, COVID-19, And Milk Banking: Can the Effects Be Recovered?

Human milk banking are facing challenges with collection of breast milk donors

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Milk banks store breastmilk for newborns whose mums can’t breastfeed them. Usually, the banks collect expressed breastmilk from pre-screened mums, who have a plentiful milk supply.

The collected breastmilk is pasteurised. It is then ready to be given to babies who most need the benefits of breastmilk. The babies who need it may be unwell, premature, or unable to breastfeed. Or their mums may not have enough breastmilk. This pathway has contributed to a life saving route to compromised infants. It also has benefited mothers who have had a pregnancy loss.

There are 17 milk banks across the UK. Each one is a member of the United Kingdom Association for Milk Banking (UKAMB).(PAID LINK)

How Has Covid-19 Affected Milk Banking?

The world of human milk banking has been heavily affected by COVID-19. As underlined in the articles of Marinelli (2020) and Furlow (2020), COVID-19 is having a negative influence on human milk donation and the human milk banking system. Donations are decreasing and the volume of milk collected from human milk banks during this period is low.

Donors’ supplies have become a concern due to the global lockdown and travel restrictions. As a consequence, parents cannot go out to bring milk to the banks, even if theoretically this can be considered an action having social value. During this period, mothers prefer to stay as far away as possible from hospitals, especially those dedicated to COVID-19.

What Is The Alternative To Human Milk Banking In Hospital?

Nowadays home milk banking is the chosen method

Since most persons are more comfortable at home the alternative is home milk collection by the milk bank staff; however, this activity has also been reduced due to the efforts required by hospitals devoted to care for people infected by COVID-19. In Italy, a special service for home milk collection, called the Human Milk Link, has been active for two of the three human milk banks in Milan (Mangiagalli Hospital and San Giuseppe Hospital), along with the Human Milk Bank of Turin. It is operated by a midwife, specialized in lactation, who has organized all the required activities to make the service work (e.g., driving the car, collecting the milk, sealing the bottles) and providing breastfeeding advice to mothers. (PAID LINK)

During 2019, this service collected 813L of human milk from 160 donors in Milan, and 99 liters from 20 donors in Turin. Human Milk Link’s activities ceased on March 9, 2020, when the lockdown started in Italy. The donation of human milk in Milan has been completely interrupted. Fortunately, a few positive exceptions exist, for example the Human Milk Bank in Rome, Italy. This milk bank is still sending its drivers (less frequently than before) to collect milk directly at the donors’ door, without entering the residence, while wearing protective equipment. In this way, they collected 49L of human milk during the month of March, 2020 (De Rose et al., 2020b).

Did SARS-CoV-2 Pasteurization Affect Human Milk?

The effect of pasteurization on SARS-CoV-2 virus inactivation in human milk banks has still to be determined. Researchers have documented complete heat inactivation of genetically similar viruses (e.g., SARS and MERS) by treatment at 60°C for 15–30 min. (Darnell & Taylor, 2006Rabenau et al., 2005van Doremalen et al., 2014). Recently, Chin et al. (2020) reported that SARS-CoV-2 is inactivated by heating in a dose-dependent manner, with viral inactivation at a temperature of 56°C for 30 min, or at 70°C for 5 min. However, their study simulated pasteurization in small aliquots, a procedure that does not fit human milk bank protocols. Therefore, these results should be replicated in a human milk bank setting.

Taking into account the available information, a milk bank should suspend, for 2 weeks, the recruitment of mothers who are suspected or have a probable case of COVID-19, in order to ensure they do not become ill during this period (European Milk Bank Association [EMBA], 2020). If an already established donor develops clinical signs of a COVID-19 infection, a rhinopharyngeal swab is recommended. Donation should be temporarily discontinued until the result of the swab is available. If the culture is positive for COVID-19, donation should be interrupted until two consecutive negative cultures are present, then donation can restart (EMBA, 2020).(PAID LINK). The question is asked can the effects be recovered? The answer is no one knows at this time. All we can do is hope that things get back to normal as soon as possible.

Bottom Line

During this period of declining donations to human milk banks all around the world, we have to realize that the resources may need to be rationed. The low volume of donor human milk available should be allocated to the smallest and most at risk preterm infants (e.g., birth weight < 1500 grams or a gestational age < 30 weeks) to prevent NEC and other severe illnesses occurring in these extremely fragile infants. For these infants, human milk really makes the difference!