Donating Breast Milk to CHOC

CHOC Children’s has long relied on donated pasteurized breast milk to help provide the best nutrition to infants receiving care in its neonatal intensive care unit (NICU).

And starting this summer, CHOC is initiating a breast milk donation service that CHOC_Breastmilk_bankwill allow women to donate extra breast milk in the name of CHOC.

Under the program, women pump milk at home, freeze it and send it to a third-party company, Prolacta Bioscience, for processing and safety testing. After pasteurizing and standardizing, Prolacta sends the finished product to CHOC.

Under the program, CHOC will be able to maintain an adequate supply of donor milk, regardless of the how many local women donate, says Dr. Christine Bixby, a CHOC neonatologist.

“CHOC was probably one of the earliest adopters of using donor milk in our preterm population,” she says. “The trend is to use donor milk and this is approaching a standard of care where if you do not have maternal milk, you use donor milk for the preterm babies.”

Dr. Bixby hopes that the new program will help encourage more women to donate milk, especially because they know their milk will help babies in their local community.

“There are a lot of people who don’t know what to do with their extra milk,” she says. “So, any moms who have too much milk can look into donating it, rather than throwing it out. These babies can really benefit from the donor milk and it’s a limited resource. This would be a great gift.”

Medical experts have found that donor human milk is an excellent alternative to a mother’s breast milk, and that premature babies tolerate donated human milk better than formula.

“The data is quite strong in the use of a human milk-based diet,” says Dr. Bixby.  “There’s a lot about breast milk that is so much better than formula.”

Learn more about our breast milk donation program.

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Breastfeeding Premature Infants

breastfeeding_preemiesParents of premature infants face many new challenges as they help their special infant grow and flourish, and breastfeeding is often one of them.

“Breastfeeding a preemie is possible but the exclusive breastfeeding of a baby, especially the earlier premature babies, is not always nutritionally appropriate,” says Dr. Christine Bixby, a CHOC Children’s neonatologist who specializes in caring for premature infants.

There’s rarely a case where a premature baby can’t get some breast milk, she says. For example, in CHOC’s neonatal intensive care unit (NICU), nurses add powdered formula to breast milk to increase the nutrient levels.

“The breast milk is the best base, so we add some nutrients and that helps the baby grow,” says Dr. Bixby, who is involved in research studies focusing on issues related to breast milk, establishing a milk supply and using breast milk for premature babies.

Mothers of premature babies often have difficulty producing milk or sustaining production, Dr. Bixby says.

“Oftentimes moms are unable to make milk early in the process or sustain it, which given the prematurity of their baby, isn’t surprising,” Dr. Bixby says.

So, while the baby is at CHOC, lactation consultants and other specialists are available to help and encourage a mother to pump, if possible. The best way for a mother of a premature baby to establish a milk supply is to begin pumping as early as possible, ideally within six hours of delivery, she says. The mother should attempt to pump regularly, which physicians understand can be challenging when her baby is in the NICU.

For early feedings, donor human milk is an excellent alternative to a mother’s breast milk. CHOC purchases breast milk from a milk bank to offer babies whose mothers cannot produce milk, Dr. Bixby says. Milk donors are tested and the banked milk is completely safe, she adds.

Specialized formulas are also available for later feedings and following discharge. These both provide extra nutrients to help older premature babies grow, Dr. Bixby says.

“If the milk doesn’t come, regardless of why, it’s not worth dwelling on it,” she says. “Parents should ask their doctor about the best formula available and focus on creating a nurturing and loving environment for their baby.”

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New Process Leads to Safer Breast Milk Handling

20130423_0279 CHOC Children’s is seeing fewer breast milk feeding errors after a more than two-year initiative to redesign the process for safer and more efficient handling.

With very few government regulations in place, hospitals across the country struggle to establish best practices in handling breast milk, and CHOC is no different. Busy nurses are often tasked with collecting, labeling, inventorying and distributing dozens of bottles during a shift, amidst other critical responsibilities.

“Our nurses are doing a multitude of highly important things, often being pulled in many directions at once,” said Caroline Steele, director of CHOC’s Clinical Nutrition & Lactation Services. “Without good support and a better system in place, there was potential for interruptions and errors.”

In June 2011, CHOC’s Joint Leadership Committee formed a process improvement team, including a physician co-chair and representatives from each inpatient nursing unit, Clinical Nutrition and Lactation, Quality and Transport. The team reviewed data from the previous 12 months and identified possible handling errors, such as storage problems, incorrect labels and instances of patients receiving the wrong milk.

Breast milk errors can spread diseases and20130423_0293 infections and, in some cases, are reportable events to the California Department of Public Health. If the wrong milk is handed to a mother who then views a patient’s private information on the label, that event would be a reportable breach of the Healthcare Insurance Portability and Accountability Act (HIPAA) as well.

A New Method

In January 2013, the team moved milk preparation to a centralized location. The existing formula room was repurposed to accommodate both formula and breast milk preparation. Now referred to as the Nutrition Lab, it houses a breast milk freezer and a commercial dishwasher and is staffed with registered dietetic technicians. CHOC also operates a satellite nutrition lab in the CHOC Children’s Neonatal Intensive Care Unit (NICU) at St. Joseph Hospital.

CHOC then secured a $190,000 grant from UniHealth to purchase the Timeless™ Breast milk Tracking system. The software uses unique barcode identifiers to ensure babies are matched with the correct milk, and that the milk has not expired. The system launched in November 2013 in the NICU, medical and surgical units, neuroscience unit, oncology unit, pediatric intensive care unit (PICU) and cardiovascular intensive care unit (CVICU) at the hospital’s Orange campus.

Nurses previously fortified and prepared milk themselves at the bedside – a contamination risk – and then had to ask a second nurse to verify the accuracy of it at every step. That accuracy check is now done automatically.

“It used to take at least an hour to make your shift’s worth of milk,” NICU nurse Jenn Landman said. “That’s an hour you can spend with a baby’s family or do extra things, like bath time or a ‘spa day’ with a baby. It’s much more meaningful work.”

Now, when a mother checks in with her baby, a nurse prints labels for the breast milk expressed during their stay and scans the baby’s armband to verify the labels are correct. The mother attaches a label to a filled bottle, which is transferred to the Nutrition Lab for inventorying and storage. The lab’s technicians fortify the milk per doctor’s orders and deliver 12 hours worth of feedings back to the units twice a day.20130423_0267

All information about the milk is documented in the baby’s medical record.

In the first two months of the barcode program, 11,232 breast milk feedings were prepared by the Nutrition Lab, with 100 percent compliance to scanning in the lab and 97 percent compliance on the units.

“This gives moms that sense of security that human error has been taken out of the equation,” Landman said.

Next Steps

CHOC’s efforts have been noticed. The California Department of Public Health has commended the program and has asked Steele to train registered dietitian surveyors across the state on proper breast milk handling.

Meanwhile, plans are being made to implement the barcode system at CHOC Children’s at Mission Hospital, and the team hopes to purchase software to track formula, as well. They are seeking additional grant funding.

Starting this month, CHOC will also conduct a study that uses a new analyzer to identify the components of a mother’s milk, rather than assuming it contains generalized amounts of nutrients. That will make the fortification process more accurate, making sure babies are getting exactly what they need.

“We are always looking at ways that we can make our hospital safer and ultimately a better experience for the patient and family,” Steele said.

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Happy World Breastfeeding Week 2012

By Cindy Baker-Fox, RN, IBCLC, lactation consultant at CHOC Children’s

August 1-7 marks the 20th annual World Breastfeeding Week (WBW), a yearly event which began in 2002, by the World Alliance for Breastfeeding Action (WABA). World Breastfeeding Week is now recognized and celebrated in more than 170 countries worldwide. It commemorates the joint efforts of WHO (World Health Organization) and UNICEF in their collaboration and development of the Innocenti Declaration, a policy created to protect, promote, and support breastfeeding throughout the world. The Innocenti Declaration remains a cornerstone in guiding public and private breastfeeding policies, practices, and programs throughout every continent and most countries worldwide.

World Breastfeeding Week aims to celebrate this historic event and its ongoing impact on the health of babies and mothers around the world through breastfeeding awareness, education, and support. The theme of World Breastfeeding Week  2012 is “Understanding the Past—Planning the Future.”  It is a time to reflect on the progress made in breastfeeding promotion and education and the ongoing efforts that are still to be made.

In 2002, WABA launched the first WBW with a campaign known as the “Baby-Friendly Hospital Initiative”. This campaign began a worldwide push to provide breastfeeding education, services, support, and trained lactation staff in every delivery hospital, clinic, and birthing center worldwide and to every women and newborn, despite their circumstances and resources culturally, socially, or economically. The goal was to reach every mother and newborn with proper information and skills to promote breastfeeding as a means of reducing infant mortality and morbidity worldwide.

According to UNICEF’s State of the World’s Children Report 2011, 136.7 million babies are born worldwide and only 32.6% of them are breastfeed exclusively in the first six months.  In July 2012, the WHO reported that, “poor breastfeeding rates contribute to over a million avoidable child deaths each year.”  Breastfeeding is a human rights issue that required the development of international policies and practices to assure adequate nutrition for every newborn.  This is truly a week to remember and celebrate.

At CHOC, we strive to support and promote breastfeeding for our patients.   CHOC’s lactation program began in 2001 with the hiring of a full time RN, IBCLC (International Board Certified Lactation Consultant).  Since then, CHOC’s commitment to optimal nutrition for our tiny babies and at risk patients has lead to additional funding for staff to provide lactation services throughout the hospital.  The Clinical Nutrition and Lactation program at CHOC currently employs 3 registered nurses and 2 registered dietitians who are IBCLC’s as well as 4 Certified Lactation Educators (CLE).  Throughout CHOC many staff have participated in various levels of lactation training including the completion of the Certified Lactation Educator training.

To further support our patients’ unique lactation needs, CHOC has hosted several educational opportunities for healthcare professionals, including a joint conference with the American Medical Association in 2009, the La Leche League  Conference in 2012, and the recent annual hosting of the University of California—San Diego CLE course.

CHOC’s lactation program is rich in history and our commitment to the core values and goals set forth 20 years ago by WHO, UNICEF, and WABA will continue to lead us in our pursuit for optimal nutrition for our young patients and further CHOC’s commitment to providing lactation services to all those in need. Join us in celebrating World Breastfeeding Week 2012!

For more information on World Breastfeeding Week and how you can become involved visit http://worldbreastfeedingweek.org.

For additional lactation information or services, visit the Clinical Nutrition and Lactation Department’s Web page.

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