Texas Milk Bank

Physicians

How are milk donors screened?

Donors of human milk are healthy lactating mothers who are screened through medical and lifestyle histories, blood tests for HIV, HTLV, hepatitis B and C, and syphilis, and microbiology cultures of their milk. Medical records for the donor and her baby are obtained from their physicians.

Donor screening meets the guidelines set forth by the Human Milk Banking Association of North America (HMBANA). These strict guidelines were developed in collaboration with the FDA and CDC and are very similar to guidelines followed by blood and tissue banks.

 

Is the milk bank accredited or inspected?

The Mothers’ Milk Bank of North Texas (MMBNT) adheres to the strict guidelines set forth by HMBANA (Guidelines for the Establishment and Operation of a Donor Human Milk Bank). MMBNT is assessed for adherence to the guidelines by a member of the HMBANA board annually. MMBNT is 100% compliant and exceeds these guidelines in several areas.

 

Is the milk pasteurized?

Yes. All donor human milk (DHM) is pasteurized using the Holder Method, a process of heating milk to 62.5° C for 30 minutes in a shaking water bath. The processed milk is then rapidly cooled and frozen and stored at -20°C or colder. Milk is only dispensed once a post-pasteurization culture shows no growth. Our pasteurization processes strictly follow the guidelines set forth by the Human Milk Banking Association of North America.

The pasteurization process kills bacteria, CMV and other viruses such as HIV while still preserving immunologic properties unique to human milk. The macronutrients are unchanged by pasteurization.

 

How is donor human milk packaged?

Donor human milk from MMBNT is packaged in 100 ml bottles. The bottle is designed and tested specifically for the processing and distribution of DHM. It is made of a high density polyethylene (HDPE) that is Bisphenol A (BPA) and phthalate free. The material is stable and will not leach into the milk. It is safe to warm and freeze milk in this material. Please note there is a tamper- evident break-away ring on the lid. The bottles are labeled with the expiration date, the batch number and nutritional information.

 

How does a hospital order milk?

A representative from the hospital need only call the Mothers’ Milk Bank of North Texas Monday –Thursday 9am-3pm to place an order. We accept Friday orders from 9am-noon only in urgent situations. Many hospitals set up MMBNT as a vendor account and provide us with a purchase order number with each milk order. Some hospitals simply order by phone and an invoice is sent for each order.

Infants that are hospitalized can only receive milk if the hospital orders and receives it. Parents are not able to order, pick up and take to the hospital themselves milk for their infant that is in-patient. If a baby will go home on donor human milk, please direct the parents to call us when preparing for discharge. We are happy to help them through the process of receiving milk for their baby at home.

 

Is milk always available?

Availability of DHM depends entirely on our volunteer donor mothers. We do our best to match our donor recruitments efforts with the current need for DHM; however, occasionally the demand is greater than our supply. In these cases priority is given to hospitalized infants. The responsibility for making decisions regarding priority is the responsibility of the executive director and medical director in consultation with the medical advisory council and a baby’s healthcare provider.

In the event of limited supplies for hospital orders we will attempt to contact another milk bank to assist us in filling our high priority orders.

 

How is the milk delivered?

Milk is delivered to Dallas-Fort Worth area hospitals by courier and can usually be delivered the same day (although we always appreciate 24 hours notice if possible).

For hospitals outside of the Dallas-Fort Worth area:  Milk is shipped by FedEx in insulated shipping containers frozen on dry ice. Orders placed by noon will be received by the hospital by 10:30 am the next day.

 

How do we know if the milk is nutritionally adequate?

Variability of macronutrient content in donor human milk is of concern to milk banks that prioritize service to VLBW infants. MMBNT has been using nutritional analysis of donors’ milk in order to target pool – deliberately mix donors’ milk in volume-specific ways in order to obtain a minimum of 20 calories per ounce for hospital clients. Each bottle of milk contains a label that lists overall caloric content, and specific nutritive protein content. In order to determine and verify these values, milk is tested from each individual donor and from each pool of donor milk post-pasteurization.

Infrared analysis has been shown to precisely and accurately measure fat, protein, and lactose in human milk. Donor human milk from MMBNT is analyzed using the Foss Electric MilkoScan FT120 which utilizes an automated full-spectrum infrared laser spectroscopy calibrated for human milk to evaluate macronutrient content. Working with the USDA, Federal Milk Market Administration, and Parker Analytical, the accuracy of the calibrations are maintained within the dairy standard of .02, with a repeatability factor of .006. The infrared method is defined in the Official Methods of Analysis of the Association of Official Analytical Chemists. Specifically: AOAC Official Method 972.16 Fat, Lactose, Protein and Solids in Milk.

MMBNT distributes milk to hospitals having a caloric content of 20 KCal/Oz. Should the NICU be caring for neonates needing a higher nutritional content, 22 KCal/Oz and 24 KCal/Oz donor milk may also be available in limited quantities. Differentiation among these bottles will be indicated by the colored labels on the lids listing the nutritional content of each bottle, as well as the batch number and expiration date and bar code on the side of the bottle.

 

Is the milk cultured after pasteurization?

Yes. All donor human milk dispensed by MMBNT is cultured for bacterial growth. Once a final report of “no growth” is received from our medical laboratory the milk is available to dispense.

A culture media is inoculated with a sample of pasteurized milk and incubated for 48 hours at 35C. All cultures are preformed at a local CLIA and CAP accredited lab.

 

How long can we use an open bottle of milk?

Donor human milk is sterile when dispensed. Current evidence has shown that after thawing, “refrigerated human donor milk [with no additives such as fortifier], when handled carefully in the clinical setting, does not grow bacteria over the course of a week.” J Hum Lact 22(4), 2006 p. 464-465.

 

MMBNT recommends that recipient hospitals store and use refrigerated thawed DHM within 24 hours of thawing. MMBNT follows storage guidelines from the Human Milk Banking Association of North America’s publication, Best Practice for Expressing, Storing and Handling Human milk in Hospitals, Homes and Child Care Settings, 3rd Edition, 2011. MMBNT recommends that recipient hospitals have a copy of this document. This document can be purchased on-line at www.hmbana.org.

 

What steps are taken to maximize the safety and security of the milk?

All milk is shipped to NICUs in new, clean insulated containers using new foam packing material to minimize contamination of the outside of the bottles that will be at the bedside of vulnerable infants. Milk bank staff packing the donor milk use clean technique. Each container is packed with dry ice to insure the product remains frozen. Each bottle cap is sealed with a tamper-evident break-away ring. Each insulated box is sealed with tamper evident tape. The NICU staff member that receives the shipping container should inspect the box to make sure the milk arrives completely frozen solid and the tamper seal is in place.

Milk dispensed in the Dallas/Fort Worth area is delivered by bonded courier in rolling ice chests. Milk is transported in sealed bags to prevent contamination of the outside of the bottles. Each ice chest is thoroughly cleaned and sanitized between deliveries. Milk never leaves the possession of the courier and is signed in with the designated person at the receiving institution.

 

Is utilizing donor human milk cost-effective?

One cost model found that for every dollar that an NICU spends on providing donor human milk for vulnerable babies, the NICU saves between $11 and $37. J Hum Lact 18(2), 2002 p.172-176. Research regarding necrotizing enterocolitis (NEC) and hospital length of stays indicate that NEC typically increases the infant’s length of stay by two weeks and adds between $128,000 and $238,000 to the cost of hospitalization. A human milk diet for these infants can help protect them from NEC. In addition to NEC, the use of DHM can reduce the incidence of other complications such as sepsis and retinopathy of prematurity

 

How much does Donor Human Milk Cost?

The milk is donated to the milk bank by mothers who are not compensated, much like blood donation. The milk bank charges recipients a tissue-processing fee. The processing fee helps to offset the cost of testing and screening donors and processing and testing the milk.

Processing fee structure is as follows:

Pasteurized Donor Human Milk

 

Current Processing Fees

Per ounce

Per 100 ml bottle

(3.33 ounces)

20 Kcal/ounce

 

$4.40

$14.65

22 Kcal/ounce

 

$5.84

$19.45

24 Kcal/ounce

 

$6.85

$22.81

 

Please order by the number of bottles desired not the number of ounces. Processing fees do not include shipping. Actual shipping charges are billed to the recipient hospital.

 

Is there a standard consent form for the use of donor human milk?

There is no standard form required by MMBNT for hospitalized infants. Many hospitals require parents to sign a consent form that the hospital has generated. Some hospitals require no specific consent form. We are happy to provide your hospital with a standard sample of a consent form. There are sample forms, policies and guidelines regarding the use of donor human milk in hospitals found in Appendix 6 of the publication, Best Practice for Expressing, Storing and Handling Human milk in Hospitals, Homes and Child Care Settings, 3rd Edition, 2011. This publication is available at www.hmbana.org.

 

What record keeping is required?

Each feeding of donor human milk should be documented in the medical record with the batch number, expiration date and milk bank name. Records of donors, donor screening information and pump dates are kept at the milk bank for each batch pasteurized and dispensed. MMBNT can track each batch of milk from donor to recipient and from recipient to donor in a matter of minutes through our database.

 

Contact Information:

 

Mothers’ Milk Bank of North Texas

600 West Magnolia Avenue

Fort Worth, Texas 76104

817-810-0071

Fax 817-810-0087

Toll free 866-810-0071

www.texasmilkbank.org

amy@texasmilkbank.org