Presentazione sul tema: "Human Milk Bank Processes: YOUR FACILITY AND LOCATION"— Transcript della presentazione:
1 Human Milk Bank Processes: YOUR FACILITY AND LOCATION Guido E. Moro, MDPresident of Associazione Italiana Banche del Latte Umano Donato (AIBLUD)Milan, ItalyTel.:
2 TWENTY- SEVEN MILK BANKS IN 2012 HUMAN MILK BANKING IN ITALY:TWENTY- SEVEN MILK BANKS IN 2012TRENTINO ALTO ADIGETrentoDr. Giuseppe De Nisi, Head Nurse Maria Luisa ZattoniLOMBARDIAMilanoPIEMONTETorinoProf. Enrico Bertino,Head Nurse Elisabetta PunzianoMoncalieriDr. Antonio Marra,Ms Patrizia SorianiFriuli Venezia GiuliaUdineHead Nurse Monica FantiniPordenoneDr.Alberto Coprivez, Head Nurse Helene Huber, Ms Gianna PollettiVENETOCamposampieroProf. Carlo Zorzi, Head Nurse Mariuccia BruseghinTrevisoProf. Onofrio Sergio SaiaEMILIA ROMAGNACesenaDr. Augusto BiasiniModenaProf. Fabrizio Ferrari, Dr. Bruno Mordini, Head Nurse Giovanna CuomoReggio EmiliaDr. Giancarlo Gargano, Dr. Claudio RotaTOSCANAArezzoDr. Pier Giorgo D’Ascola, Ms Manuela CaneschiFirenzeDr. Claudio Profeti, Dr. Fina BelliGrossetoDr. Rita Bini, Ms Sandra NovelliLido di CamaioreDr. Ilaria Merusi, Ms Alessandra ManfrediLuccaDr. Raffaele Domenici, Dr. Simona Tognetti, Ms Bruna GiampaoliSienaProf. Mirella Strambi, Ms Angela PoleseABRUZZOChietiDr. Mariangela Conte,Ms Lucilla CampionePUGLIABariDr. Antonio del Vecchio, Ms Ottavia BinettiFoggiaDr. Giovanna Minelli,Dr. Rosario MagaldiSan Giovanni Rotondo, FoggiaDr. Alberto Gatta,Dr. Antonio Villani,Dr. Pasqua QuitadamoLAZIORomaDr. Giuseppe Morino,Dr. Anna Maria CappelliCALABRIACosenzaDr. Maria Pia Galasso, Ms Francesca De LucaCrotoneDr. Massimo Bisceglia, Dr. Vincenzo PoerioSICILIAAgrigentoDr. Adriano Azzali, Head Nurse Fazeo GioachinoPalermoDr. Iwona KazmierskaFOR COMMUNICATIONItalian Association of Human Milk Banks - Associazione Italiana Banche del Latte Umano Donato (AIBLUD)Adress: c/o Biomedia, Via Libero Temolo 4, 20126, Milan, ITALY Website:Secretariat: Cristina Benelli Tel.:
3 Background info Brief description How did your human milk bank (HMB) began? When?Collecting Human Milk to feed premature infants admitted to the NICU of Macedonio Melloni Maternity Hospital, the second largest maternity in Milan.It began in the year1985.Who provided initial funding? How are ongoing operations funded? Integrated into government services?It started as a Service of the Hospital. Part of the funds were given from the Italian National Council of Research, part from private donation, and part from the Hospital.After that, it became a regular service supported by the hospital (National Health Service).Who regulates /oversees HMB in your country/region (if any)?No “official” organization regulates/oversees HMB. The banks are following the Italian Guidelines published in 2005, revised in 2007 and in In the year 2012, Italian National Recommendations for the Organization and Management of HMB have been published as the result of a cooperation between the Italian Ministry of Health and the Italian Association of Human Milk Banks (AIBLUD). According to this agreement, the National Health Service will monitor the functioning of HMB through AIBLUD.How many HMBs are part of your system? Where are they?27 (26 are included in hospitals and belong to the Public Health Service, 1 bank is managed by a private diary company). They are located mainly in the North and Center of our country.Is there a central HMB that processes milk and distributes or many HMBs that process milk and distribute?All the banks are processing and distributing the milk.How many NICU/Neonatal wards/community homes does each bank serve? Are they collocated?The majority of the banks are serving mainly their own NICU, but some are serving also 2-3 other NICUs of the same region.How many babies does your facility/system serve annually?All the babies with a BW < 1800 g admitted to the NICU (app. 90), plus the infants < 1250 g admitted to the NICU of Lecco Hospital (app. 20 babies), plus external babies.How many liters/year does your facility/system process annually?In the year 2010 we have collected and processed 1,500 liters of donated human milk.How many donor mothers initiate donation to your facility/system annually?In the year 2010 we had 222 donors (135 internal mothers of premature infants, and 87 external mothers of term infants).
4 Process Staffing Donor recruitment Donor screening Brief description of processesStaffing1 full time nurse1 part time doctorDonor recruitmentInterviewDonor screeningLife styleMaternal therapiesMaternal diseases and serological testingRecipient eligibility and selectionAccording to the Italian Guidelines (Journal of Maternal-Fetal & Neonatal Medicine’s, September 2010; 23(S2): 1-20)Handling and storage of donor milk (from donation to feeding)
5 Process Transport of milk Pasteurization Tracking and record keeping Brief description of processTransport of milkHome service with a car of the hospitalPasteurizationHolder pasteurizationTracking and record keepingRoutinely performedAssessing milk quality and safety (ie. microbiology assays)Pre-pasteurization testing:1) at the first donation2) when the donor does not seem to guarantee appropriate hygienic conditions3) periodically, in a random wayPost-pasteurization testing:1) in a regular way (e.g. once a month or every 10 cycles)2) when there are concerns about the processingQuality assuranceAccording to the principles of Hazard Analysis and Critical Control Points (HACCP)
6 Equipment/Location What is used/how many? Brief description of processWhat is used/how many?Pasteurizer: 1 SterifeedFreezers: 3 freezers at – 20°CRefrigerators: 2 refrigeratorsAdditional HMB equipment requirements?Computer : 1 devoted to the bankOther : Milk Scan Analyzer (Foss Electric); osmometer (De Mori)Referral/feeder/depot facilities?How many?Equipment requirements?Neonatal ward equipment requirements?System for tracking usage?Freezer?Other?
7 Organizational Successes Brief description of top 3-5 successesPolicyNational policy and support for breastfeeding. Impact of breastfeeding promotion on HMB; impact of HMB on breastfeeding promotion (increased number of breast feeding mothers at discharge home in the NICU with a HMB: national survey. Exclusive breastfeeding at discharge in the 19 NICU with HMB 29.6% vs 16% of the 64 NICU without HMB. Any breastfeeding 60.4% in NICU with HMB vs 52.8% in NICU without) .OperationalImpact of HMB on infant health outcomes (reduced incidence of NEC, sepsis, and better feeding tolerance). Utilization of donated human milk in the nursery (supplementation of mother’s milk in term infants in the first days of life in specific circumstances: e.g. excessive loss of weight, dehydration).TechnologyMacronutrient evaluation of donated human milk, and storage of the milk according to the protein content.
8 Organizational Challenges Brief description of top 3-5 challengesPolicyLack of interest from Regional GovernmentEconomical crisisSome neonatologysts do not believe in HM for feeding VLBW infantsOperationalContinuous update of the staff to maintain a high level of qualification.TechnologyPasteurization method should be improved to preserve better the nutritional and biological quality of human milk, maintaining at the same time the microbiological safety of the final product.