Abstract

PIP: Staff of the neonatal intensive care unit (NICU) at the L.T.M.G. Hospital in Bombay, India exclusively feeds all infants breast milk. A lactation management nurse oversees its formal milk banking system by encouraging health mothers of NICU infants to donate milk and by assessing daily milk demand. Breast milk donors must fit predetermined criteria, such as not taking medication and not be malnourished. Prior to expressing breast milk, each mother must wash her hands and breasts. She expresses milk either by hand or by using a manual or an electric pump. She must try to empty each breast every 2 hours with the milk going into a sterile container. A certain amount is fed fresh to her infant. The remaining milk is placed in a larger container which is then put into a refrigerator. At the end of each day, all excess milk is placed into a single container and transferred to a milk bank freezer in an insulated box. The nurse sends a sample to be tested for the present of microorganisms. If the number of microorganisms in the milk exceed certain criteria, it then is pasteurized at 56 degrees Celsius for 30 minutes thereby inactivating microorganisms including HIV. Unpasteurized milk is kept in the freezer for no longer than 1 month while pasteurized milk can be stored for up to 3 months. Daily, predetermined amounts of milk is thawed. thawed milk is then transferred in insulate boxes to the refrigerator in the NICU to be used within 24 hours. As much as possible, infants receive their own mother's fresh milk. If not, they are fed screened donor milk appropriate for gestational age. Some problems for this system include unwillingness of mothers to share their breast milk and outbreaks of diarrhea when pumps are not sterilized after each use.