The Human Milk Bank saves the lives of our youngest

A year ago, the Human Milk Bank opened at the University Hospital Centre Zagreb. This project is the result of cooperation between the Ministry of Health and UNICEF, initiated by the Croatian Association of Breastfeeding Support Groups. Despite the challenging circumstances where for several months milk could not be collected from donor mothers, about 300 litres of donated human milk were successfully collected, giving about a hundred children the opportunity for a better start in life and lowering the risk of complications associated with premature birth.

"Given the circumstances, we are satisfied with the first year. The first year of launching a programme is always a challenge in every way, and this one was especially so. During the first wave of the COVID pandemic, we could not collect milk for more than six weeks because at that time there was insufficient data on the risks of SARS-CoV2 virus transmission through human milk. There were also problems of a logistical nature, such as the organisation of maternal blood sampling for testing for blood-borne diseases. People were afraid to come to the hospital or let health workers into their homes," said Dr. Branka Golubić Ćepulić, head of the Clinical Institute for Transfusion Medicine and Transplantation Biology, within which the Human Milk Bank also operates.

"Now that the virus is better known, we know that there is no reason not to collect donated milk that is very much needed for preterm and sick children whose mothers do not have enough milk in this stressful situation. We were also hit by a strong earthquake in Zagreb when, due to damage to the building, babies had to be moved from one maternity ward to a different hospital. In such extraordinary situations, where mothers and children cannot be together, donated milk and the Human Milk Bank play a huge role," said Dr. Anita Pavičić Bošnjak,  Head of the Breastfeeding Support Department within the Human Milk Bank.

Any woman who has breastfeeding difficulties that require diagnosis and treatment can contact the Breastfeeding Support Department, says Dr. Anita Pavičić Bošnjak: "The examination is performed with a referral from a general practitioner or gynaecologist or primary care paediatrician. They can contact us through the email address medicina.dojenja@kbc-zagreb.hr. The department provides support for breastfeeding to donor mothers and potential donors and all other mothers who need it and who contact us."

The largest amount of milk was delivered to girls and boys who were being treated at the Institute of Neonatology and Neonatal Intensive Care of the University Hospital Centre Zagreb. This is where children from all over Croatia whose life is at risk are accommodated. When a mother, for various reasons, is unable to provide milk for her child being treated there, the child is fed donated milk, which is prescribed as a medicine. Prof. Ruža Grizelj, Head of the Institute, explains that breast milk is a medicine for seriously ill children, and adds:

"In situations where it is not possible for the mother to breastfeed, we start feeding newborns with donated milk, which has a clear advantage over formula. Preterm infants who are given donated milk have almost a two-times lower risk of developing necrotising enterocolitis, a severe bowel disease that entails a high risk of later neurodevelopmental delay in a number of patients and could be fatal in the most severe cases. To date, no drug or procedure has been discovered to achieve the effect that breastmilk has. The setting up of a milk bank has further improved the quality of healthcare in the Institute."

"The vision of the Human Milk Bank is to act at the national level and supply all units of intensive care with donated human milk. We are already sending milk to the University Hospital Centre in Osijek, we are now ready for the University Hospital Centre in Split, and are preparing to cooperate with the University Hospital Centre in Rijeka, and then with other hospitals," Dr. Branka Golubić Ćepulić went on to tell us.

Even at the time of the strictest lock-down measures, the Institute for Neonatology and Neonatal Intensive Care of the University Hospital Centre Zagreb allowed unlimited visits for mothers who, on these occasions, stayed with their children and maintained skin-to-skin contact, expressed milk, and also breastfed.

"Contact between mother and child is an irreplaceable link for establishing not only breastfeeding, but also for a woman's psychological health and strengthening the emotional bond that is abruptly broken when the mother is separated from the child. Today, visits are also allowed, although we can say with some slightly stricter epidemiological measures. Mothers bring milk from home, which we then store in a freezer or refrigerator provided to us by UNICEF, for which we are very grateful. We are trying as hard as we can and, so far, we have not had any negative experiences regarding SARS-CoV-2. It cannot be stressed enough how important and irreplaceable the promotion of lactation and breastfeeding is for the health of premature babies. It serves as both food and medicine to preterms. It might sound amazing, but, as seen in serious clinical research, an intake measured in mere millilitres can have an incredibly positive effect! For all these reasons, the visits will be the last to be suspended and, in this regard, we have the full support of the Management of the University Hospital Centre Zagreb," says Prof. Ruža Grizelj.

The exceptional circumstances in which we all currently live can affect the establishment of lactation in mothers who are separated from their babies.

"This pandemic is an extraordinary circumstance for the whole world and for the health system in all countries. This means that sometimes the mother and the child are separated in the first days of birth or later if the child requires hospital treatment. This, together with the present uncertainty and fear for the child and apprehension in general in these uncertain times, obviously does not have a favourable effect on breastfeeding. But we should think positively and stimulate and maintain milk production by expressing milk. Each extra drop or quantity of expressed milk should be seen as a small victory because this breastmilk will reach a maternity ward, it will reach a baby and help him or her. And then, when the mother and the child are together again, they will be able to continue breastfeeding," advises Dr. Anita Pavičić Bošnjak.

The Human Milk Bank had 63 donors in the past year, which is seen as very positive, but it is clear that more donor mothers will be needed in the future to ensure sufficient quantities of breastmilk for every girl and boy who needs it.

"As more and more hospitals begin to use human milk, there is a growing need. So, we kindly ask any mother who has excess breastmilk to think about donating to the Human Milk Bank. This is how they will provide a good start not only for their baby but also for premature babies and/or severely ill babies who cannot feed on their mother’s milk. They can contact us via e-mail at banka.mlijeka@kbc-zagreb.hr or by phone at 01-4604-715, said Dr. Branka Golubić Ćepulić.