Review of guidelines on expression, storage and transport of breast milk for infants in hospital, to guide formulation of such recommendations in Sri Lanka

Abstract

BackgroundSick newborns in neonatal units who are unable to breastfeed are fed expressed breast milk. In Sri Lanka, most mothers stay in hospital throughout baby’s stay to provide this milk freshly. In other countries mothers go home, express breast milk at home and bring it to hospital. There are concerns about the safety of transported expressed milk if used in a tropical middle-income country. The aim of this paper is to compare and contrast advice offered by different hospitals and organizations on how to express, store and transport breast milk safely.MethodsWe assessed guidelines used by hospital staff of the four Level 3 neonatal units in Melbourne, Australia, National Health Service UK, guidelines and training manuals of the Human Milk Banking Association of North America, the World Health Organization and an information leaflet from Family Health Bureau, Sri Lanka. Information on breast milk expression, storage and transport provided by the guidelines were tabulated under seven topics: general information; container for milk collection; hand expression; using a pump for expression; storage; thawing / warming; and transport of expressed breast milk. The AGREE II tool was used to assess the guidelines written for hospital staff.ResultsThere was considerable agreement on most recommendations provided by these sources, but no single source covered all topics in full. Most recommend hand expression as the initial method for expressing of breast milk, followed by breast pump use, except the Sri Lankan recommendations which strongly discourages the use of breast pumps. Durations of storage under various conditions are generally similar in the different recommendations. Most guidelines recommend a ‘cool box’ or container with ice or freezer packs for transportation of milk.ConclusionA single document containing recommendations on all aspects of expressing, storing and transporting breast milk should be available for each unit, with the same basic information for mothers and the healthcare staff and further technical details for staff if required. The Sri Lankan recommendations need to be updated based on current worldwide practices and further studies are needed to establish a safe method of transport of expressed breast milk in Sri Lanka.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1244-2) contains supplementary material, which is available to authorized users.

Mothers' Experiences in Milk Management Out of the Hospital: a Qualitative Study

“…The main information for 22% of mothers comes from uno cial sources-for example, websites-and these resources may not recommend the same methods as the o cial guidelines [25]. The Internet and peer instruction were also other important sources of knowledge for participants in this study, but the scienti c nature of the information from these channels was not certain.…”

“…The Sri Lankan health agency strongly recommends against the use of pumps to express human milk. One hygiene concern is that pumps are considered a potential source of harmful bacteria [25]. In a survey in Melbourne, Australia, it was found that only 54% of mothers correctly understood the information on the refrigeration times of expressed HM [25].…”

“…This study explored how mothers manage HM out of the hospital, which revealed their ideas on management through three themes. Australian researchers found that the surface temperature of refrigerated fresh HM transferred to the NICU was higher than the temperature (1°C-4°C) recommended by the hospital, and some mothers did not put refrigerated HM in insulated food containers, resulting in the temperature of these samples of HM being higher than the temperature in the insulated food container [25]. Changes in temperature may reduce the biologically active factors as well as the nutritional and microbiological value of fresh HM [35,36].…”

Peningkatan Pengetahuan Ibu Nifas tentang Manajemen ASI Perah di Kabupaten Bangka Tengah

“…Berbagai macam penelitian telah dilakukan untuk memudahkan ibu dalam menyimpan ASI yang telah diperah untuk bayinya, antara lain Rodrigo, Amir, & Forster (2018), Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (2019), serta Ogundele (2000). Harapannya, walaupun ibu menemui kendala dalam proses menyusui, ibu tetap dapat memberikan ASI-nya secara eksklusif.…”

Human Milk Expression, Storage, and Transport by Women Whose Infants Are Inpatients at a Tertiary Neonatal Unit in Melbourne, Australia

“…Guidelines have been developed and published on how mothers can minimize this contamination. [17][18][19][20][21] These guidelines include topics ranging from hygienic practices the mother should containers that can be used, how to express milk manually or by pump, how to clean/disinfect pumps, safe transport methods, and storage durations. Our review of guidelines in 2018 includes recommendations specifically meant for transporting expressed MOM for an infant in hospital.…”