Momentum is gathering to establish a network of centralised human donor breast milk banks for pre-term babies in hospitals across Australia.

At the moment there are only five breast milk banks in Australia: two in Brisbane (one of these is run by a private charity), one in Sydney, one in Heidelberg, Victoria and another in Perth.
Tasmania, South Australia, Australian Capital Territory and Northern Territory do not have milk banks.

Dr Ben Hartmann, who manages Australia’s first human breast milk bank, PREM Bank at King Edward’s Hospital in Perth, spoke to Government News about the talks he is having (outside his role at the hospital) with a major not-for-profit organisation  about the possibility of setting up a national network or service of milk banks supplying donor milk to pre-term babies across the country.

Dr Hartmann said milk banks were critically important for hospitalised pre-term, sick and high risk infants if a mother was struggling with her supply and as an alternative to formula.

Medical research has shown that breast milk can reduce the rate of life-threatening conditions that pre-term babies are particularly susceptible to, such as neonatal sepsis, a blood infection, and necrotising enterocolitis (NEC), a gastrointestinal disorder.

The science has shown that breast milk improves outcomes for infants, reduces the costs of hospital care and makes it much more likely a woman will go home breastfeeding.

The localised statistics back up Dr Hartmann’s case. King Edward’s Hospital used to have similar rates of NEC – around 8.5 per cent – to other Australian hospitals but NEC rates have fallen to about 3.9 per cent since the hospital’s milk bank opened in 2005 (using latest 2012 figures).

A 2014 paper, Donor Human Milk Banking in Australia – Issues and Background Paper – by the Commonwealth Health Department – says 90 per cent of all NEC cases are in premature babies.

Although talks are getting increasingly serious between Prem Bank and the national organisation to explore the options for setting up centralised milk banks across Australia, significant hurdles must  be negotiated first: funding, staffing and designing a national model.

PREM Bank is run from within the hospital’s neonatal intensive care unit (NICU) but it is not a separate line item in the unit’s budget. While milk bank staff are full-time, this is not always the case in milk banks attached to other hospitals.

While there are more than enough mothers wanting to donate milk – the hospital turns many away – and strong fundraising for equipment through local Rotary club, Dr Hartmann said it was the lack of clear legislation and additional funding that proved challenging.

“It’s the funding for the on-going cost and the funding for people to do the job. We’re really well supported by the community. Getting new salaries for people to process the milk in the current public health funding climate is what we struggle with,” he said.

Donated breast milk is currently regulated under the Food Standards Australia New Zealand but Dr Hartmann believes it could be better regulated by the Therapeutic Goods Authority (TGA), given some of the risks associated with milk donation, such as the transmission of viruses like HIV, are currently already regulated by the TGA in similar donor-reliant industries, for example, blood, tissue and bone donation.

“[breast milk should be regulated at] the lower end of the range of the high standards required by the TGA, rather than operating at the extremes of food regulation,” he said.

Running a milk bank takes work: potential donors must be screened using blood tests and a health questionnaire and milk must be pasteurised, frozen, stored and thawed safely. Milk is quality tested before and after pasteurisation.

Ideally, Dr Hartmann believes that milk banks should be run by not-for-profits, removed from hospitals but supplying them and that this service should be available to pre-term infants in every state.

“It’s not equitable at the moment to have hospitals that have access and others that don’t and it appears that the current model of the NICU-based milk bank is only working in a limited number of hospitals. It’s time for a re-think,” he said.

Milk banks could sell milk to hospitals but only to cover costs. There is also the possibility that surplus milk could be sold for a small profit,
for example, to the parents of full-term infants where mothers are struggling with supply. This occurs in other jurisdictions but is not a model supported by Dr Hartmann.

One model that could be used to establish a network of milk banks is that of blood banks, which Dr Hartmann says are block funded at federal level.

While the milk banking principle is supported of all levels of government none have offered to fund such a network.

Supplying breast milk makes economic sense, explains Dr Hartmann, because it costs $250,000 to care for an infant who is sick with NEC but only $250 per litre of milk.

Premature babies tend to only consume small amounts, as little as 0.5ml initially, and go through only two litres during the average hospital stay of a few months. A full-term baby, in comparison, will guzzle 750ml to a litre a day.

“We are now saving about $360,000 per annum in terms of the costs of care of survivors from NEC,” Dr Hartmann said.

“A single day in the NICU costs about $2,500. In the context of the NICU donor human milk is a low cost intervention. There’s an element of frustration that we’re having to justify the service. It’s attractive on a cost and clinical outcomes basis.”

Human donor breast milk is a service much in demand, including from mothers of full-term babies who are struggling with their supply.

The Facebook page for online community milk service Human Milk for Human Babies has daily posts of people offering or requesting breastmilk. Donors are not paid – at least, they are not supposed to be – and neither are they screened, or their milk tested.

In the US breast milk is regularly bought and sold online, with few controls in place and many of them are really struggling with credibility.