Lactation: The cyclical process of milk synthesis and secretion from the mammary gland is termed as lactation. It occurs with the help of two hormone, prolactin and oxytocin. In humans the process of feeding milk is called breastfeeding or nursing. The chief function of lactation is to provide nutrition and immune protection to the young after birth. In almost all mammals, lactation induces a period of infertility, which serves to provide the optimal birth spacing for survival of the offspring. Physiology of lactation: The physiological basis of lactation is divided into four phases: 1. Preparation of breasts (mammogenesis). 2. Synthesis and secretion from the breast alveoli (lactogenesis) 3. Ejection of milk (galactokinesis) 4. Maintenance of lactation (galactopoiesis)

1. Presented by –
Diksha Singh
Ph.D Human Nutrition
Ist year

2. • Physiology of lactation
• Milk synthesis and secretion
• Maternal needs during lactation
• Composition of colostrums and mature
human milk
• Milk of mothers of preterm babies
• Non-nutritional factors of human milk
• Human milk banking

3. • The cyclical process of milk synthesis and secretion is termed
lactation
• Lactation occurs with the help of 2 hormones: prolactin and
oxytocin
• During the second stage of lactogenesis,the breast becomes
capable of milk production but for the ongoing synthesis and
secretion of human milk,the mammary gland must receive
hormonal signals
• These signals produced by direct response to stimulation of
the nipple and areola (mammae), are then relayed on central
nervous system

5. • Breast
– Made up of milk-producing glands
– Supported and attached to the chest wall by
ligaments
– Rests on pectoralis major muscle
• Three major hormones affect the breast
– Estrogen, progesterone, and prolactin

6. • Breast contains 15-20 lobes
• Fat covers the lobes and
shapes the breast
• Lobules fill each lobe
• Sacs at the end of
lobules produce milk
• Ducts deliver milk to
the nipple

7. • Embryonic morphogenesis
• Pubertal growth
• Pregnancy induced growth
• Terminal differentiation during lactation

8. Role of Hormones
(primes mammary gland)
• Estrogen : growth of ducts
• Progesterone : growth of alveoli
• Placental Lactogen : growth of milk producing
cells in the alveoli
• Prolactin : helps growth of ducts and alveoli /
stimulates alveoli cells to produce milk

9. Hormones involve in the processes of mammary
development during pregnancy and lactation

10. Four phases:
 Mammogenesis –further growth of the breast
 Lactogenesis –the initiation of milk synthesis and
secretion from breast alveoli
• Lactogenesis stage I
• Lactogenesis stage II
 Galactokinesis –ejection of milk
 Galactopoiesis –maintenance of lactation

11. Breast Development Cycle The Lactation Cycle

12.  Proliferation of the distal
elements of the ductal tree,
creating multiple alveoli
 Breast enlarge to twice their
normal weight
 Increase in mammary blood flow
 The areola of the nipples
pigmentation and diameter
increases
 The Montgomery’s glands
enlarge
 By the 16thweek (2ndtrimester)
the breasts begin to produce
colostrum
Change during pregnancy

13. Stage I (16-28 wks of
gestation)
• Substrate for milk
production collect in breast
tissue
• Early secretion –
production of colostrum
starts
• High levels of progesterone
have a negative(inhibitory)
effect on lactogenesis

14. Stage 2 (30-40 hrs. after birth
to day 8): the onset of
copious milk secretion
• The presence of PRL levels
stimulates the onset of copious
milk production and secretion.
• The breasts will begin to
produce milk independent of
infant suckling.
• Breasts are full with milk.
Endocrine control switches to
autocrine (supply/demand)
control.

15. • Discharge of milk from the mammary glands
depends not only on the suction exerted by the baby
during suckling but also on the contractile
mechanism which expresses the milk from the alveoli
into the ducts
• Milk let down reflex/ milk ejection reflex
• Inhibited by psychic condition/ pain/ breast
engorgement

16. Neuroendocrine reflex control of PRL and oxytocin
secretion during lactation

17. Milk synthesis and secretion
During sucking, a neuroendocrine reflex is set up:
Mechanoreceptors in nipple and areola
Ascending sensory (4,5,and 6) afferent neural arc
PVN & SON of hypothalamus
Oxytocin from posterior pituitary
Contraction of myoepithelial cells
(milk ejection or milk letdown reflex)
Milk is forced down into the ampulla of lactiferous ducts,
wherefrom it can be sucked by the baby

18.  The production and maintenance of mature milk from day 9
postpartum until Mom and baby decide to wean.
 Controlled by the autocrine system, but hormones do still play a
role.
 Prolactin is the most important galactopoietic hormone
 Continuous sucking is essential for removal of milk from glands, also
release Prolactin
 The more milk that is removed from the breasts, the more milk will
be produced. Milk production relies on the supply and demand
principal.
Involution (average 40 days after last breastfeeding):
Milk secretion decreases from the buildup of inhibiting peptides.

19. Control of Milk Synthesis
• Milk contains a small whey protein called Feedback Inhibitor of
Lactation (FIL) – the role of FIL appears to be to slow milk synthesis
when the breast is full. Thus milk production slows when milk
accumulates in the breast (and more FIL is present), and speeds up
when the breast is emptier (and less FIL is present).

20. • On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin
receptor sites that allow the prolactin in the blood stream to move into the
lactocytes and stimulate the synthesis of breast milk components.
• When the alveolus is full of milk, the walls expand/stretch and alter the shape of
prolactin receptors so that prolactin cannot enter via those receptor sites – thus
rate of milk synthesis decreases.
• As milk empties from the alveolus, increasing numbers of prolactin receptors
return to their normal shape and allow prolactin to pass through – thus rate of milk
synthesis increases.
• The prolactin receptor theory suggests that frequent milk removal in the early
weeks will increase the number of receptor sites. More receptor sites means that
more prolactin can pass into the lactocytes and thus milk production capability
would be increased.

22. Lactation period

23. Maternal needs during Lactation
Lactating mother’s nutritional requirement should
meet
1. Her own daily needs.
2. Provide enough nutrients for the growing infant.
3. Furnish the energy for the mechanics of milk
production.
Diet of lactating mother and her nutritional status
during pregnancy affect to a certain extent quality
and quantity of breast milk.

24. RDA for Lactating mother
Requirement Lactation
0-6 months 6-12 months
Body weight (kg) 55 55
Net energy additional (kcal/d) +600 +520
Protein (g/d) 77.9 70.2
Visible Fat (g/d) 30 30
Calcium (mg/d) 1200 1200
Iron (mg/d) 25 25
Vit. A(µg/d) Retinol 950 950
ß-carotene(µg/d) 7600 7600
Thiamine (mg/d) +0.3 +0.2
Riboflavin (mg/d) +0.4 +0.3
Niacin equivalent (mg/d) +4 +3
Pyridoxine (mg/d) 2.5 2.5
Ascorbic Acid (mg/d) 80 80
Dietary folate (g/d) 300 300
Vit.B12 (g/d) 1.5 1.5
Magnesium (mg/d) 310 310
Zinc (mg/d) 12 12

25. Nutritional requirements
Energy: The recommended energy increase is 600 kcal for the first six months
and 520 kcal for the subsequent 6 months, more than the usual adult
allowance. The additional calorie is required for milk production.
Protein: During lactation, additional protein is necessary for the synthesis of
proteins of the breast milk, which are secreted to feed the infant. The protein
content of human milk is 1.15g/100ml. During lactation, protein requirement
has been computed on the basis of secretion of 9.4 g per day of protein in
milk during 0-6 months and 6.6 g during 6-24 months.
Fat: The minimum level of total fat should be 20%E.Adult pregnant and
lactating females, should consume at least 200mg/d DHA for optimal adult
health and fetal and infant development. To furnish 20 %E total fat, diets of
pregnant and lactating women should contain at least 30 g visible fat.

26. Iron: Iron requirement during lactation is the sum of the requirement of the
mother and that required for making up the iron lost in breast milk. Since
there is amenorrhea during lactation, resulting in saving of nearly 1mg of
iron/day or 16 μg/ kg/bw/d,which would otherwise have been lost in the
menstrual blood.
Calcium: Additional calcium is required for milk secretion. Mother’s milk
contains 30-40 mg/100ml.The total calcium secreted through milk is about
300mg/d.
Vitamin A: Since milk is a rich source of Vitamin A(retinol), a lactating mother
needs additional amount of this vitamin. The average Vit.A secreted in
mother’s milk is 350 μg of retinol/day

27. Thiamin: The thiamine in breast milk secreted by Indian poor women is below
15µg per 100ml. Thiamine content of mother’s milk depends on mother’s
diet. Dietary allowances for thiamine for lactating mother are 0.5mg/1000kcal
and their daily requirement is computed on the basis of their energy
allowance.
Riboflavin: The riboflavin content of breast milk of Indian poor mother is
about 17µg per 100ml. With supplements, the concentration can be raised to
30µg per 100ml. The amount of riboflavin lost through milk is 0.23mg per day.
Additional allowance of riboflavin corresponding to the increased energy
allowance would be 0.3mg. RDA for riboflavin during lactation is computed on
the basis of 0.6mg per 1000kcal. Milk is a good source of calcium.
.

28. Niacin: The nicotinic acid content of breast milk of Indian women ranges
between 100 and 150 µg per 100ml. The amount lost in milk is between 0.9
and 1.2 mg per day. The dietary allowance for niacin is 6.6mg niacin
equivalents per 1000kcals.
Folic acid: The folic acid content of breast milk secreted by Indian women is
1.6 µg per 100ml. At the higher level, the amount of folate lost by the mother
would be about 25 µg a day. An additional allowance for 50 µg of folate
should be provided during lactation.
Vitamin B12: The amount of Vitamin B12 secreted in milk per day is 0.25-0.3
µg. An additional intake of 0.5 µg per day would cover the needs during
lactation. Vegan nourishing mother should take supplements.

29. Vitamin C: The additional needs during lactation are calculated on the basis
of the vitamin C secreted in milk. Assuming a daily milk secretion of 700 ml
milk with an ascorbic acid content of 3mg/dl by well-nourished women, the
additional requirement during lactation will be 20mg. Taking into
consideration the cooking losses (50%) the expert committee recommends an
additional intake of 40mg per day during lactation.
Fluid: An increased intake of fluid is necessary for adequate milk production,
since milk is a fluid tissue. Water and beverage such as juices, soups, butter
milk and milk all add to the fluid necessary to produce milk. A lactating
mother should take 2-3 litres of fluid per day

30. Composition of colostrums and mature
human milk
 The first 2-4 days postpartum
 Yellowish milk due to its high b-carotene content
 High concentration of proteins (lactoferrin)
 Low levels of lactose and fats
 The volume is approximately 100 cc in a 24-hour
period.
Transitional milk : Is secreted between about 4 to 10 days
postpartum.
Intermediate in composition in between colostrum and mature milk.

31. Colostrum
Property Importance
Antibody-rich Protects against infection
and allergy
Many white blood cells Protects against infection
Purgative Clears meconium; helps
prevent jaundice
Growth factors Helps intestine mature;
prevents allergy,
intolerance
Vitamin A-rich Reduces severity of some
infection (such as measles
and diarrhea); prevents
vitamin A-related eye
diseases

32. Composition of Colostrum
Nutrient Values per 100ml
Energy (Kcal) 58
Protein (g) 2.7
Fat (g) 2.9
Lactose (g) 5.3
Iron(mg) 0.09
Calcium (mg) 31
Phosphorous (mg) 14
Carotene (IU)
Vitamin A (IU)
186
296
Composition of mature human
milk
Nutrient Values per 100ml
Energy (Kcal) 65
Protein (g) 1.1
Carbohydrate (g) 7.4
Fat (g) 3.4
Calcium (mg) 28
Phosphorous (mg) 11
Carotene (µg) 137
Thiamine (mg) 0.02
Riboflavin (mg) 0.02
Vitamin C (mg) 3

33. Mature human milk
 Atfer days 10 postpartum
1. Foremilk:
• milk secreted at the start of breastfeeding
• watery, rich in protein, sugar, vitamins and minerals.
• necessary to satisfy baby's thirst.
2. Hind-milk:
• comes later towards end of feed.
• Provides the highest fat and more calories
• important for baby to feel satisfied and to gain
adequate weight.

34. Specific Nutrients in Human Milk
Milk Component Early Milk Mature Milk
Lactose (g) 20-30 67
Total protein (g) 16 9
Fat% 2 3.5
Calories 0 2730-2940
Retinol (mg) 2 0.3-0.6
Caretenoids (mg) 2 0.3-0.6
Riboflavin (ug) 0 400-600
Niacin (mg) 0.5 1.8-6.0
Vitamin B6 (mg) 0 0.9-0.31
Pantothenic acid (mg) 0 2-2.5
Biotin (ug) 0 5-9
Folate (ug) 0 80-140
Vitamin B12 (ug) 0 .5-1.0
Vitamin C (mg) 0 100
Vitamin D (microgram) 0 0.33
Vitamin E (mg) 2-12 3-8
Vitamin K (microgram) 2-8 2-3
Calcium (mg) 250 200-500
Phosphorus (mg) 120-160 120-140
Magnesium (mg) 30-35 30-35
Copper (mg) 0.5-0.8 0.2-0.4
Iron (mg) 0.5-1.0 0.3-0.9
Zinc (mg) 8-12 1-3
Human Milk Composition (per liter)

35. Milk of mothers of preterm babies
The preterm babies are breastfed with unprocessed human milk obtained
from their mothers. It has been shown that milk of mother delivering
prematurely has higher calorie, fat, protein and sodium content which is
suitable for the nutritional needs of low birth weight babies. Anti-microbial
property of breast milk is of great importance to the preterm babies and the
incidence of infectious sepsis meningitis is greatly reduced. If the baby
does not gain weight satisfactorily with breast milk alone, dietary
supplements like vegetable oils (corn oil, groundnut oil) may be used
which increases the caloric value without increasing its volume. The
advantage of feeding preterm babies is protein and fat easily digestible and
feeding tolerance.

36. Human Milk Facts
• Isotonic Solution
– milk and plasma are of similar ion concentration
• Designed to protect infants chronic childhood
diseases.
– T-lymphocytes, B-lymphocytes, neutrophils, macrophages
and epithelial cells aid in protection
• Two forms of breast milk are colostrum and mature
milk.

37. Colostrum in Human Milk
• Thick, yellow fluid
• Produced during lactogenesis II (2-3 days after
birth)
• Provides 58-70 cal/100 ml
• High in protein, electrolytes, sodium,
potassium, chloride and vitamin A
• Low in fat and carbohydrate
• Lactobacillus bifidus factor

38. Mature Human Milk
• Thin and watery texture
• Forms during lactogenesis III
• Provides 2,730-2,940 cal/L
• High in linoleic acid and cholesterol content for brain
development
• High in fat content and lactose
• Docosahexaenoic acids (DHA)
– Long chain omega-3 fatty acids.
– Used for synthesis of brain tissues, central nervous
system and eyes
• DHA and cholesterol not found in human milk substitutes

39. Mature Human Milk- PRO
• Protein
– Low content
• Dependent on infant’s age
– Antiviral and antimicrobial effects
– Casein
• Major protein in mature milk
• Casein, calcium phosphate, and other ions such as
magnesium and citrate is what makes milk appear
white.

40. Mature Human Milk- CHO
• Lactose
– Disaccharide of galactose and glucose.
– Dominant carbohydrate in human milk.
– Enhances calcium absorption.
• Other carbohydrates
– Monosaccharides
• Glucose
– Polysaccharides
• Contribute calories
• Stimulate the growth of bifidus bacteria in the gut
• Inhibit the growth of E. coli and other bacteria

42. Immunologic properties of human milk
• Human milk immunoglobulins:
• Human milk contains all of the different antibodies (M, A, D,
G, E), but secretory immunoglobulin A (sIgA) is the most
abundant.
• During time of reduced neonatal gut immune function, the
infant has limited defense against ingested pathogens.
Therefore, sIgA is an important protective factor against
infection.
• IgA is important because it coats and seals baby's respiratory
and intestinal tract to prevent germs from entering his body
and his ​bloodstream.

44. Other immunologic properties of human milk
• Immunoglobulins are antibodies that fight off the germs that cause illness
and disease.
• In addition to antibodies, human milk has numerous factors that can affect
the intestinal micro flora of the baby. These factors enhance the
colonization of some bacteria while inhibiting the colonization by others.
• The immunologic components include :
 lactoferrin, which binds to iron, thus making it unavailable to pathogenic
bacteria
 lysozyme, which enhances sIgA bactericidal activity against gram-
negative organisms
 oligosaccharides, which intercept bacteria and form harmless
compounds that the baby excretes
 milk lipids, which damage membranes of enveloped viruses and mucins,
which are present on the milk-fat globule membrane.

45.  interferon and fibronectin have antiviral activities and enhance lytic
properties of milk leukocytes.
 Bifidus factor supports the growth of lactobacillus. Lactobacillus is a
beneficial bacteria that protects the baby against harmful bacteria by
creating an acidic environment where it cannot survive.
• Human milk leukocytes:
• Macrophages comprise 40-60% of the cells in colostrum, with the
remainder of cells primarily consisting of lymphocytes and
polymorphonucleocytes.
• By 7-10 days postpartum, with the transition from colostrum to
mature milk, the percentage of macrophages then increases to 80-
90% at a concentration of 104 -105 human milk macrophages per
milliliter of milk.
Milk leukocytes can tolerate extremes in pH, temperature and
osmolality.

46. 46
Immunologic Content

47. Bioactive properties of human milk
• Human milk also contains growth modulators, such as epidermal
growth factor (EGF), nerve growth factor (NGF), insulin like
growth factors (IGFs) and interleukins. Transforming growth
factor (TGF)–alpha, TGF-beta, and granulocyte colony-
stimulating factor (G-CSF) are also identified in human milk.
• These growth modulators are produced either by the epithelial
cells of the mammary gland or by activated macrophages,
lymphocytes (mainly T cells), or neutrophils in the milk.
• EGF and TGF-alpha were found at higher concentrations in the
milk of mothers who delivered prematurely compared with
those who delivered at term.

48. Enzymes
• Human milk contains various enzymes; some are
specific for the biosynthesis of milk in the mammary
gland (eg, lactose synthetase, fatty acid synthetase,
thioesterase), whereas others are specific for the
digestion of proteins, fats, and carbohydrates that
facilitate the infant's ability to break down food and
to absorb human milk.

49. • Amylase is the main polysaccharide-digesting enzyme. It
digests starch. Since babies are born with only a small amount
of amylase, they can get this essential digestive enzyme
through breast milk. After six months of age, a child's
pancreas begins to release amylase.
• Protease speeds up the breakdown of proteins. There are
high levels of protease in breast milk. It is believed that this
enzyme is important for digestion especially during the period
right after birth.

50. • Lipase: Newborns can fully digest and use the fat in
breast milk because of lipase. Lipase breaks down
milk fat and separates it into free fatty acids and
glycerol. Newborns get energy from free fatty acids,
and lipase makes those free fatty acids
available before digestion occurs in the intestines.

51. • Lactoferrin is an iron-binding protein. It helps baby to absorb iron.
Also, along with white cells and antibodies, lactoferrin kills bacteria.
Lactoferrin stops E. coli from attaching to cells and helps to
prevent infant diarrhea. Lactoferrin also prevents the growth
of Candida albicans, a fungus. Lactoferrin levels are very high in
preterm breast milk and the levels go down as lactation continues.
• Lysozyme protects an infant against bacteria such as E.
coli and Salmonella. The levels of lysozyme in the breastmilk rise
especially around the time babies begin eating solid foods. The
increase in lysozyme helps to protect children from germs that can
cause illness and diarrhea.

52. The Hormones in Breast Milk
• The following hormones are found in the breast milk.
• Prolactin: is the hormone responsible for the production of
breast milk. Colostrums, the first breast milk, has high
amounts of prolactin. But, after the first few days of
breastfeeding, the amount of prolactin goes down quickly.
• Thyroid Hormones: TSH, T3, and T4:
• Thyroid hormones are secreted by the thyroid gland. The
most important function of the thyroid hormones is to control
how the body breaks down food and turns it into energy. This
process is called metabolism.

53. • Thyroxine (T4) levels in colostrum start out low, but they go up during the
first week of breastfeeding. Thyroxine may help the intestines of a newborn
develop and mature. Small amounts of triiodothyronine (T3) and thyroid-
stimulating hormone (TSH) have also been identified in breast milk. It's
believed that the thyroid hormones in breast milk help to protect a
breastfed newborn from hypothyroidism.
• Epidermal growth factor is a major growth factor that stimulates cell
growth. It has many functions, but it is especially important for development
and maturation of the gastrointestinal (GI) tract or digestive system of
newborns. EGF can be found in blood, saliva, amniotic fluid, and breast milk.
Right after childbirth, the colostrum contains high amounts of epidermal
growth factor.
• Beta-Endorphins
• Endorphin hormones are the body's natural painkillers. The beta-endorphins
found in breast milk are believed to help newborns deal with the stress of
birth and adjust to life outside of the womb. There are higher levels of beta-
endorphins in the breast milk of women who have a normal vaginal delivery,
a premature baby, and those who do not get an epidural during childbirth.

54. • Relaxin from the name, relaxes or loosens muscles, joints and
tendons. During childbirth, relaxin in the body works to help
soften the cervix and loosen the pelvis to prepare for delivery.
It may also have an effect on the growth of the milk-making
tissue of the breasts.
• Erythropoietin (EPO)
• The production of red blood cells in the body is called
erythropoiesis. Erythropoietin is a hormone that's made by the
kidneys and it tells the body to make more red blood cells. This
hormone does pass into the breast milk and it may help to
stimulate the production of red blood cells in the newborn.

55. • Cortisol is often called the stress hormone. In colostrum, cortisol is
high, but the levels go down quickly and stay at lower levels as
breastfeeding continues.
• Women who are happy and have a positive breastfeeding
experience, have been shown to have less cortisol in their breast
milk. The amount of cortisol in the breast milk can affect the
amount of Secretory Immunoglobulin A (sIgA).
• It help infants control the movement of fluids and salts in the
digestive tract, be involved in the growth of the baby's pancreas
and play a role in helping an infant deal to with chronic stress.

56. • Leptin
• The hormone leptin is made by the body's fat tissue. It
controls appetite, weight and how much energy the body
uses. The leptin in breast milk may help to control a baby's
weight.
• Studies show that when breast milk contains more leptin,
babies have a lower body mass index (BMI). So, leptin may
help to prevent obesity in breastfed babies.
• Other Hormones Found in Breast Milk include
gonadotropin-releasing hormone (GnRH), insulin,
progesterone, estrogen, androgens, gastrin, adiponectin,
resistin, and ghrelin.

57. HUMAN MILK BANK
“There is only one pretty child and healthy milk
in this world, and every mother has it.”

58. Introduction
• Breastfeeding is the best method of infant feeding because
human milk continues to be the only milk which is uniquely
suited to the human infant.
• When a mother, for some reason, is unable to feed her infant
directly, her breast milk should be expressed and fed to her
infant.
• If mother’s own milk is unavailable or insufficient, the next
best option is to use PDHM.

59. According to PATH BLOG, JULY 31, 2016.
• In India, an estimated 30 to 50 percent of the most vulnerable
babies are in neonatal intensive care units (NICUs) need and would
benefit from donated human breastmilk.
• Milk banks not only provide donor human milk to babies in need,
they provide a safe way for lactating mothers to donate and store
milk.
• Providing human milk to newborns results in fewer infections,
increased intelligence, even probable protection against unhealthy
weight gain and diabetes, and could prevent an estimated 823,000
deaths in children under the age of five, every year.

60. WHO ranking of feeding options
for newborns
• Best
1. Mother’s own breast milk (fresh)
2. Donated fresh preterm milk
3. Donated fresh term mature milk
4. Pasteurized donated breast milk
5. Preterm formula
6. Ordinary formula
• Worst

61. History of Milk Banking
• Historically “wet nursing” was the first form of human milk donation where
infants were breastfed by women other than the mother.
• 1909 - first European milk bank was established in Vienna
• 1919 - first US milk bank was established in Boston
• 1985 - Human Milk Bank Association of North America was formed to set
standards for North American milk banks.
• Though wet nursing had been in practice since mythological ages, modern human
milk banking is in its infancy in India. However, the concept of human milk
banking in Asia was initiated by an Indian doctor, Armanda Fernandes on
November 27, 1989, under the name of ‘Sneha’, at a Mumbai hospital.
• Currently, the number of human milk banks has grown to nearly 22 all over India
but the growth of human milk banks have been very slow as compared to the
growth of neonatal intensive care units.

62. Why are Donor Milk Banks Needed?
• Human milk provides optimal
nutrition, promotes growth &
development, & reduces the risk
of illness and disease.
• Some mothers are unable to
provide all the breastmilk their
infants need.
• In the absence of mother’s own
milk, donor milk is the best
substitute.

63. Why use donor milk?
• Human milk also contains
growth factors that can:
– protect immature tissue
– promote maturation, particularly
in the gastrointestinal tract
– promote healing of tissue
damaged by infection.

64. Who needs donor milk?
• Conditions in which donor milk
is provided:
– Prematurity
– Allergies
– Feeding/formula
intolerance
– Immunologic deficiencies
– Post-operative nutrition
– Infectious diseases
– Inborn errors of
metabolism

65. Necrotizing Enterocolitis (NEC)
• Frequent and lethal disease affecting the GI tract of
premature infants
• Average mortality is 30-40%
• Incidence among formula-fed infants in NICU 12-15%
• Incidence among breastmilk fed infants in NICU 1.5%

66. What is a Human Milk Bank?

67. • A human milk bank
(HMB) is a service
established to recruit
breast milk donors,
collect donated milk,
and then process,
screen, store, and
distribute the milk to
meet infants’ specific
needs for optimal
health.

68. • Pasteurizer/Shaker-water bath:
• 62.5 °C (30 minutes).
• shaker water bath (steel, double walled) with a micro-processor controlled
temperature regulator.
• other safer methods- flash heat treatment, HTST (High Temperature Short
Time: 72.C for 15 seconds) and UV irradiation
• Deep Freezer:
• to store the milk at -20° C.
• 2 Deep Freezers -1. to store milk till the post pasteurization milk culture
reports are available.
• To store the pasteurized milk once the culture reports are negative and the
milk is considered safe for disbursement.
• Refrigerators:
• to store the milk till the whole day’s collection is over and the milk is ready to
be mixed and pooled for further processing.
• for thawing the milk before being dispatched.
Equipments

69. • Hot Air Oven/Autoclave:
• for sterilizing the containers.
• Breastmilk pumps:
• hospital grade electric pumps- result in better volumes of expressed milks and
are relatively painless and comfortable to use.
• Pump and its parts should be sterilized/disinfected.
• Containers:
• Collecting and storing milk.
• single use hard plastic containers of polycarbonates, pyrex or propylene are
used across the world.
• India- cylindrical, wide mouthed stainless steel containers (200 ml) with tightly
screwed cap (equally effective).
• Generator/Uninterrupted Power Supply: uninterrupted power supply backup
to run the deep freezers and refrigerators
• Milk analyzer:
• macronutrient analysis of breastmilk - calorie, protein and fat, using infra-red
spectroscopy technology.
• In teaching hospitals - a step towards lacto engineering.

70. Who can donate?
A lactating woman who:
• is in good health, not regularly on medications or herbal
supplements;
• is willing to undergo blood testing for screening of infections;
• has enough milk after feeding her baby satisfactorily and baby
is thriving nicely.
• mothers whose babies are in NICU,
• mothers who have lost their babies but are willing to donate
their milk.

71. Who cannot donate?
A donor is disqualified who:
• uses illegal drugs, tobacco products or nicotine replacement therapy;
or
• regularly takes more than two ounces of alcohol or its equivalent or
three caffeinated drinks per day; or
• has a positive blood test result for HIV, Hepatitis B or C or syphilis; or
• has received organ or tissue transplant, any blood transfusion/blood
product within the prior 12 months.
• is taking mega doses of vitamins, which are known to be toxic to the
neonate and excreted in breastmilk; or
• has mastitis or fungal infection of the nipple or areola, active herpes
simplex or varicella zoster infections in the mammary or thoracic
region.

72. Key Steps in Human Milk Banking

73. Types of Donor Milk Available
• Early Full Term: from first 7-10 days post partum
• Preterm: for infants under 1500 grams and/or less than 36
weeks gestation
• Full Term: for infants at or over 36 weeks gestation (Also used
routinely for premies when preterm not available )
• Non-fat: for treatment of infants with chylothorax (0.0 - 0.3%
fat)
(Chylothorax- excess fluid builds around the lung)

74. Effects of pasteurization on human breast milk
• With holder pasteurization most of the secretory IgA, bifid growth factor, and
lysozyme remain (0% to 30% destroyed), lipids are unaffected, but 57% of the
lactoferrin, and 34% of the IgG are destroyed.
• However, holder pasteurization [62.5°C (144°F) for 30 minutes] inactivates
bacterial and viral contaminants such as cytomegalovirus, HIV and human T-
lymphotropic virus and fosters rapid growth of intestinal epithelial cells.
• In general, the nutritional components are altered somewhat, resulting in
slightly slower growth when compared to infants fed unpasteurized raw
human milk.
• Holder pasteurization does not appear to influence nitrogen absorption or
retention in LBW infants. Most enzymes, growth factors, vitamins, and
minerals are unchanged or minimally decreased.

76. HMB LOCATION
“Sneha” at Lokmanya Tilak Municipal Hospital (1989) Sion, Mumbai
“Amaara” at Fortis La Femme (2016) Gurgaon
”Jeevan Dhara” at Mahila Chikitsalaya (2014) Jaipur, Rajasthan
“Divya” Mothers Milk Bank at R.N.T Medical College
(2013)
Udaipur, Rajasthan
Cama & Albless Hospital (2007) Mumbai
Mahatma Gandhi Hospital Jaipur
SSKM hospital Kolkata
Civil Hospital Ahmedabad, Gujrat

77. • Dvorak, B. (2010). Milk epidermal growth factor and gut protection. The Journal of
Pediatrics, 156(2), S31–S35. http://doi.org/10.1016/j.jpeds.2009.11.018
• Dvorak, B., Fituch, C. C., Williams, C. S., Hurst, N. M. and Schanler, R. J. (2003).
Increased epidermal growth factor levels in human milk of mothers with extremely
premature infants. Pediatric Research, 54(1), 15-19.
• Neville, M.C. (2008) Milk secretion an overview, http://www.health-e-
learning.com/resources/articles
• Savino, F., Liguori, S. A., Fissore, M. F., & Oggero, R. (2009). Breast milk hormones
and their protective effect on obesity. International Journal of Pediatric
Endocrinology, 327505. http://doi.org/10.1155/2009/327505
• Smolin, L.A. and Grosvenor, M. B. In the beginning nutrition for mothers and
Infants, Nutrition Science and pplication, 3rd edition, Saunders college publishing,
443-452.
• Srilakshmi, B. (2011) Nutritional and food requirements for infants, Dietetics, sixth
edition, New Age International Publishers ltd, 37-52.
• Srilakshmi, B. (2011) Nutritional and food requirements of lactating women,
Dietetics, sixth edition, New Age International Publishers ltd, 127-136.

78. • Landers, S. and Hartmann, B.T. 2013. Donor human milk banking and the
emergence of milk sharing. Pediatric Clinics of North America. 60(1):247–260.
• Wagner, J., Hanson, C., Anderson Berry, A. 2013. Donor human milk for premature
infants: a review of current evidence. ICAN: Infant, Child, & Adolescent Nutrition.
5(2):71-77.
• Human Milk Banking Association of North America. 2003. Guidelines for
Establishment and Operation of a Donor Human Milk Bank. Human Milk Banking
Association of North America Inc., Raleigh, NC. Information available at:
www.hmbana.org.
• World Health Organization. 2003. Global Strategy for Infant and Young Child
Feeding. Geneva, Switzerland;.
• World Health Organization (WHO), United Nations Children’s Fund (UNICEF).
2009. Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for
Integrated Care. Geneva: WHO, UNICEF.
• Bertino, E., Giuliani, F., Occhi, L., Coscia, A., Tonetto, P., Marchino, F., Fabris C.
2009. Benefits of donor milk for preterm infants: current evidence. Early Human
Development ;85(10 Suppl):S9–S10.