PE7.8 | Human Milk Bank — Summary & Reflection

KEY TAKEAWAYS

Human milk banks fill a critical neonatal care gap: when a preterm or VLBW infant's mother cannot provide her own milk, pasteurised donor human milk from a certified HMB is the WHO/NHM-recommended third-best option (after mother's own fresh and stored milk), and is substantially superior to formula in reducing NEC risk. The Holder pasteurisation technique (62.5°C × 30 minutes) is the standard processing method: it eliminates HIV, CMV, HTLV-1, HBV, HCV, and bacteria while largely preserving HMOs, growth factors (EGF ~70%), and residual sIgA and lactoferrin — but destroys live cells and bile-salt-stimulated lipase. Donor screening includes HIV, HBsAg, HCV, VDRL, and HTLV-1 serology. Post-pasteurisation bacteriological standard is <10 CFU/mL. Storage: refrigerator (2–4°C, 72 h) or freezer (-20°C, 3 months). India's NHM LMC guidelines (2017) govern HMB establishment in public hospitals; anonymous donation addresses most privacy concerns, while milk-kinship beliefs require sensitive counselling. Competency PE7.8 requires visiting the nearest HMB during paediatric posting.

REFLECT

Return to Baby Rohan's father from the opening scenario. He has four specific concerns: whose milk it is, whether it is safe, how it is tested, and whether it could transmit disease. Using the processing chain you have just reviewed — donor screening, Holder pasteurisation, bacteriological QC — write out exactly how you would answer each of his four questions in plain language that a non-medical father could understand and trust. Then reflect: what would you do if the father tells you that in his tradition, receiving milk from an unrelated woman is spiritually significant and he is not sure it is permissible? How does the NHM's policy of anonymous donation help — and where does it fall short in addressing his concern?