Banking on breast milk best for sick infants

Donated breast milk is ideal for preterm infants but doesn’t deliver the same benefits for older, healthier babies. WA Health

It is now widely accepted that mothers’ milk is best for babies. Breastfed infants have fewer infections and are likely to have a higher intelligence than those fed artificial formula.

But a difficulty arises after a preterm birth when mothers are asked to express milk for their baby who is too immature to suck. This is an unnatural and stressful situation, and can result in inadequate milk supply. This is where donated pasteurised milk from other mothers is most beneficial.

For a preterm baby who is unable to suckle and can’t access its mother’s milk, donated breast milk is one of the best medicines. But breast milk donations are unlikely to be of much benefit to older, healthier babies. If the milk hasn’t been screened for diseases, it can pose a serious health risk.

Whether breast milk comes from the mother or a donor, it is the ideal nutrition for young infants, containing high quality protein, hormones, and bioactive and immune factors that cannot be replicated in artificial infant formula. Feeding pasteurised donor human milk to preterm infants also lowers the risk of infections and gut disease.

Evolution suggests that the nutritional components in breast milk evolved from the innate immune system. All mammals have the capacity to produce milk for their young until the development of their own immune defences are complete.There are over 4000 different mammals with milk specific to the species.

Wet nursing dates back to 2250BC and is still practiced in indigenous communities where it may provide the best option for a baby whose mother is unable to breastfeed.

The first human milk bank was established in Vienna in 1905. Community-based breast milk banks operated in Australia until the 1980s. But when it became evident that HIV may be transmitted via breast milk they promptly closed down.

The first formal human milk bank in Australia was established in 2005 at King Edward Memorial Hospital in Perth. Mothers who donate breast milk are screened as thoroughly as blood donors for infectious diseases. Their milk is pasteurised (heat treated) to further ensure that all viruses and bacteria are eliminated. The milk bank is not-for-profit so donors are not paid.

Over the last five years, thousands of litres of pasteurised donor milk have been dispensed to over a thousand patients in the Neonatal Intensive Care Units at King Edward Memorial and Princess Margaret Hospitals in Perth.

Pasteurisation is safe but reduces the quality and activity of nutrient and immune factors in breast milk by about 40%. With new technologies to treat milk, which are currently being developed at UWA, we should be able to retain close to 100% of the bioactive factors.

Breast milk is a precious resource to sick infants but elsewhere in the world it is turning heads as an amusing delicacy. A café called “The Icecreamists” in Covent Garden, London recently served ‘Baby Gaga’ breast milk ice-cream flavoured with lemon zest and vanilla, in a martini glass ($23 per serve).

The dish was popular but caused an outcry, especially from Lady Gaga herself. She said the dish was “nausea-inducing” and “may be unsafe for human consumption”. She is even suing the restaurant. (I’m interested to know whether Lady Gaga also finds products manufactured from goat’s milk or cow’s milk “nausea-inducing”).

UK health authorities later tested the ice cream and deemed it safe. Other cities have tried different variations of breast milk products - breast milk cheese was on sale in a restaurant in New York - but so far Australia’s restaurant industry hasn’t dabbled with beast milk products and shouldn’t unless strict risk management processes are in place.

Human breast milk banking is not regulated by Australian health authorities, but formal breast milk banks adhere to strict quality and risk management processes, and have set the standard internationally. Internet-based groups, on the other hand, share unscreened and unpasturised milk with healthy babies who can’t access their mother’s own milk.

Advertising over the internet and feeding donated milk of unknown quality is risky and is not endorsed by health professionals. There is no evidence that the benefits outweigh the risks of feeding un-screened, unpasteurised milk to healthy full-term infants. Recipes for home-made pasteurisation are not sufficient to ensure safety.

The Federal Government needs to develop national regulations for the establishment and management of human milk banks in Australia to protect infants from the risk of untreated breast milk.

Breastfeeding is recommended and actively promoted for infants worldwide. In developed countries, the role of donor milk should predominately be for sick, preterm and hospitalised infants. For healthy babies unscreened donor milk is just not worth the risk.