Inducing lactation in the absence of pregnancy (nonpuerperal lactation) is not always successful and, in many cases, only partial breastfeeding is achieved. Different protocols have been described, but scientific evidence and research are lacking in this area. The authors describe the case of a woman with a history of a miscarriage, for whom the lactation induction process was so effective that she became a milk donor even before she received her adopted child. She had not previously used hormone treatment. She was given domperidone as a galactogogue for 1 month. The pumping protocol began with a double electric breast pump combined with manual pumping 6 months before her child was delivered, and 3 months later, she was accepted as a donor by our milk bank. This highlights the importance of regular stimulation as a milk production mechanism. This is the first case of human milk donation in an adoptive mother described in the literature.
The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.
The Baby-Friendly Initiative (BFI-Spain) was founded in 1995 by members of key professional associations (pediatricians, midwives, obstetricians, and nurses) and some mother-to-mother support groups. The United Nations International Children's Fund was instrumental in supporting the establishment of BFI-Spain as a not-for-profit organization. In 2007, the need for change was identified. A detailed analysis of BFI-Spain identified its main strengths, weaknesses, opportunities, and threats. A new strategic plan was devised that included the adoption of a staged accreditation system, a new website, expanding the initiative into the community, consolidating working teams to distribute tasks and responsibilities, and trying to involve the national health authorities. This article describes the analysis that was undertaken, the strategies implemented, and some of the outcomes observed 4 years later. The aim of the article is to support BFI teams in other countries who might be facing similar challenges.
Dear Editor, We have attentively read the Vickers et al 1 article about storage of pasteurized donor human milk (PDHM) at 4ºC for 96 hours. In this study, its authors resolve that there was no evidence of microbes in PDHM that had been defrosted and stored at 4ºC for up to 9 days. Previously, Slutzah et al 2 had shown how bacterial growth in fresh milk remained unchanged for 96 hours and, therefore, concluded that fresh mother's milk may be stored at refrigerator temperature for as long as 96 hours. However, they also showed how fresh milk's pH significantly decreased during this refrigeration period (from 7.21 to 6.68 over 96 hours of storage), which relates to the increase in free fatty acids. Although fresh milk appears to be safe after 96 hours of refrigeration, the acidification that takes place in this process may alter its quality. Acid milk seems to hinder calcium absorption; its proteins become thermosensitive and changes in the milk's cellular content have also been described. 3 In this same article, apart from 36 fresh milk samples, Slutzah 2 also analyzes pH evolution in 5 samples of PDHM during refrigeration and points out that it barely suffers any modifications (pH of 6.3 ± 0.1). Our team analyzed changes in pH in 30 PDHM samples stored at 4ºC for 96 hours, and we observed that the pH hardly varies (from 7.56 to 7.58). These results, together with those of Vickers, 1 suggest that PDHM stored at 4ºC for up to 96 hours remains safe regarding bacterial growth and quality due to pH stability. However, our attention is drawn to the low pH values for PDHM reported in Slutzah's article in comparison to the ones that our team obtained. The average pH values reported for fresh milk range from 7.68 to 7.07 with a median of 7.56, 4 which are very similar to those obtained in our study. In a previous research study, it was also established that the minimum acceptable pH for subsequent processing of milk in the bank would be 6.57. 5 The pH that Slutzah 2 reported for PDHM is below this limit.
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