Human Milk Bank Processes: Human Milk Bank System in Brazil

Human Milk Bank Processes: Human Milk Bank System in Brazil

Sergio Duarte Segall, Ph.D

Path Consultant in Brazil+55 31 3022-4664+55 31 [email protected]

Background info

Brief description

1940

IFF (Instituto Fernandes

Figueira)

The Human Milk Bank of the Instituto Fernandes Figueira has a direct relationship with the directions of the history of Human Milk Banks in Brazil. By being the first unit in operation between 40's and 70 it served as model institutions, replicating the proposal to operate exclusively with the collection and distribution of milk human, without developing promotional activities, protection and support breastfeeding.

From 1943 to 1985, the main problem was the need to increase the volume of milk collected. The search for an effective program that allows to expand the collection was always the subject of major concern.

With the development of the National Program for Encouraging Breastfeeding - PNIAM in 1981 in Brazil, it was observed social mobilization in favor of using human milk, which culminated in a kind of stimulus the deployment of Milk Banks, with the objective of promoting the service in times of urgency, for infants unable to be clinically directly breastfed by their mothers.

Financial support

Brief description

State and Municipal governments

National Council for Scientific and Technological

Development (CNPq)

Ministry of Health

The Compromises of MOH with RNBLH are:

1 - Expanding the Network of Human Milk Banks

2 - Updating the information system

3 - Implementation Phase II of the National Quality Program in Human Milk Bank - PNQBLH

4 – Boost the HMB into the SUS – National Health Service belongs to the MOH

5 - Revisit the National Commission on Human Milk Banks - CNBLH

6 - Supporting the State Commissions of Human Milk Banks - CEBLH and the State Reference Centers

7 - Create the Latin American Network of Human Milk Banks

8 – Coordinate the National Campaigns like the NATIONAL DAY OF DONATION OF BREAST MILK.

Brazilian HMB in numbers

Brief description

ANVISA(Regulated Agency)

In Brazil, all human milk given to babies of women that is not the biological mother should be processed according to standard operating of human milk banks - RDC / Anvisa No. 171/2006 .

In 2011 Brazil achieved the total of the211 HMB and 114 PCLH (Milk collect post) in all Brazilian states. These PCLH collect the milk and send it to the HMB to be processed.

The many of these HMB are collocated in hospitals to offer the milk to Neonatal units.

In 2011 the Brazilian HMB collected 168,054 L from 160,022 donors. The volume distributed (129,342) attended 160.666 receptors

State Group Care Individual Care Home visitDistrito 73.783 161.308 29.475Goiás 6.950 21.713 4.798Mato Grosso 832 5.103 894Mato G do Sul 8.395 27.780 8.831Alagoas 17.438 18.337 2.970Bahia 11.082 26.274 8.382Ceará 7.669 18.809 1.548Maranhão 5.805 22.234 4.237Paraíba 10.899 65.209 8.565Pernambuco 8.665 156.544 1.682Piauí 1.191 1.544 5.745Rio G do Norte 9.140 20.479 4.519Sergipe 9.950 16.718 2.573Acre 2.268 17.145 616Amapá 8.679 16.990 3.162Amazonas 10.955 3.478 3.838Pará 4.847 26.834 15.054Rondônia 3.776 22.520 2.245Roraima 7.127 8.470 1.234Tocantins 3.628 19.050 3.351Espírito Santo 2.622 17.821 2.324Minas Gerais 8.039 42.183 17.426Rio de Janeiro 9.560 107.206 6.131São Paulo 58.318 265.933 60.823Paraná 11.480 15.368 22.440Rio G do Sul 5.501 53.439 604Santa Catarina 13.065 55.900 7.526Total Brasil 321.664 1.234.389 230.993

National and Regional Reference Centers Organogram

Chief of Reference

Center

Teaching Center

Laboratory of Quality Control

Firefighters Program

IT Cluster

R&D Center

Donor Assistance

Production Service – HM

Program for Tech Development

Transport of Milk• The health professional that attend the women in hospital advised

the women to seek the milk bank by a toll free number (1-800) where women report that they want to donate the milk.

• The milk home collection is done through civil defense or fire stations in partnership with milk bank that goes to the home of donors who can not come to the hospital. The milk is transported in isothermal boxes with ice frozen out and arrives frozen in milk bank.

Figure 2 shows the car used for civil defense to visit the home donors and collect the frozen human milk.

Figure 3 - Isothermal boxes used in the process of collection and transportation of breast milk

Who can Receive the Donated Milk1 - Distribution

• Distribution of human milk to a receiver is conditional upon:

a) the prescription or requesting physician or nutritionist containing volume / daily schedule and needs of the recipient;

b) meeting the following priority criteria:

b.1) newborn premature or low birth weight that does not suck; infected newborn, especially with enteroinfections;

b.2) newborn nutrition trophic;

b.3) newborn suffering from immunodeficiency;

b.4) newborn suffering from allergies heterologous proteins, and exceptional cases, the medical criteria.

Pasteurization• LTLT (62 oC for 30

minutes)• If the acidity is higher

than 8 degrees Dornic the milk is discarded and can not be used for infant feeding.

Figura 5 - Creamatocrit and small titrator used to calculate the fat content and Dornic acidity, respectively.

Figura 4 - Water Bath for pasteurization process

Equipment/Location• All the human milk banks follow the modus operandi and the quality

standard set by Fiocruz.• The reference center cost around US$ 50K

Figure 6 – Quality control laboratory of the HMB

11

Table 1 – Quality control laboratory of the HMB

Human Milk Bank Processes: Human Milk Bank System in Brazil

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