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Newborns whose mother is unable to breastfeed them, can receive donor milk by a feeding tube.
Newborns whose mother is unable to breastfeed them, can receive donor milk by a feeding tube.

High standards for human milk banks in Norway

Few countries are as well supplied with human milk banks as Norway. But in contrast to other countries, Norwegian milk banks do not pasteurize all the donated milk. This requires strict and updated guidelines.

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Life-giving 'white blood' is the term Dr. Hedvig Nordeng uses to describe mother’s milk. She compares the twelve Norwegian human milk banks with the better known life-saving blood banks.

“The recipients of human donor milk are the smallest, most vulnerable members of our society. We are obliged to provide them with the best support we possibly can,” she says.

Nordeng is a professor at the Department of Pharmacy at the University of Oslo. She has been part of a group of clinicians and experts from a wide range of professions that has collaborated on new guidelines for the Norwegian human milk banks.

Millions of years of evolution

“Norwegian human milk banks are unique in two distinct ways. One is that we are the country in the world that donates the most mother’s milk per capita. The other is that after meticulous testing, some of the most valuable milk does not get pasteurized,” she explains.

The reason is that the heating that constitutes the pasteurization process not only kills unwanted microorganisms, it also damages many important substances that the milk contains.

“We don’t know at which point mammals started giving milk to their babies, but we do know that for millions of years evolution has been optimizing the composition of mother’s milk for each species,” Nordeng says.

Premature babies

“When we pasteurize the milk, we alter this composition, denaturate important proteins and reduce the quality of life-giving 'white blood'.”

“Evolution has been optimizing our breast milk for millions and millions of years, says Dr. Hedvig Nordeng.
“Evolution has been optimizing our breast milk for millions and millions of years, says Dr. Hedvig Nordeng.

“We wouldn’t dream of pasteurizing human blood! Even if we do have decent substitutes for mother’s milk, they lack numerous important proteins and antibodies that are unique to humans,” she says.

All Norwegian human milk banks are located in public hospitals. The donor milk is mainly intended for premature babies when their own mother is unable to breastfeed them.

“Sometimes mothers who give birth to premature babies, have problems with breast milk production for quite obvious reasons. Her body wasn’t prepared to produce milk at the time the baby was delivered.”

“Some women are also severely ill and may not be able to breastfeed their newborn child. That makes the hospital’s milk bank indispensable.”

Bank of England

The donors of 'white blood' are mothers producing more milk than their own babies need. The guidelines for human milk banks supply lists of which medications that may or may not bar them from being donors.

“We also have to know if they are using any herbal products. Some medications constitute no problem, while others require quarantine periods where the donor can’t donate breast milk,” Nordeng explains.

“We need to be one hundred per cent sure that the donor milk is of highest quality. The milk bank must be as safe as the Bank of England.”

Give answers

Nordeng points out the importance of pharmaceutical knowledge when making recommendations about medication, safety and donation of human milk.

She is currently looking forward to participating in the major European IMI research project called ConcePTION for the next five years. ConcePTION will establish a human milk bank at Uppsala University, with the aim to enable human lactation studies measuring medications in mother’s milk, but this time among mothers bPreastfeeding their own babies.

“We will be looking for women who need to use certain allergy medications and who want to donate their breast milk to this project next year, and we will give them answers about how much of the medication ends up in their milk,” she adds.