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Le don de lait

Milk donation

In 2018, French milk banks collected 44,600 litres of anonymously donated milk, yet despite this, there is a shortage of donations every year to meet all the needs.

And demand has increased in recent times.

For premature babies, there is no possible substitute — breast milk is something truly vital.

To put things in perspective, a very premature baby needs 7 litres to reach a weight that allows them to consume infant formula (approximately 1,700–1,800 g at around 34 weeks of gestation)[1]

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And needs have been higher for some time now.

For premature babies, there is no possible substitute — breast milk is something vital.

To put things in perspective, it takes 7 litres for a very premature baby to reach a weight that allows them to consume infant formula (approximately 1,700–1,800 g, around 34 weeks of gestation)[1]

Take care mama

Si vous allaitez votre enfant, vous pouvez quand même tirer votre lait pour en faire don. Vous aurez toujours assez de lait. 

What is a milk bank?

This is a facility where mothers' milk is analysed and pasteurised, either for their own premature baby in hospital (personal donation) or for other babies (anonymous and free donation).

Please note that practices differ between hospitals for personal donations — some give raw milk, others pasteurised milk [2]. It is quite a sensitive subject.

Decision criteria may also vary:

One of the factors is the risk of exposure to CMV (cytomegalovirus infection). Seroprevalence in women is 40 to 50%. 

In the majority of cases, there is a reactivation of CMV with excretion into breast milk. Premature babies have not been able to benefit from the maternal antibodies progressively transferred from the third trimester onwards.

Another factor in the decision may be where the milk was expressed (if it was expressed in the ward rather than at home: there would be a greater risk of cold chain breaks for milk collected at home and transported).

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Which babies receive the donated milk?

Le lait est utilisé le plus souvent pour des bébés hospitalisés. Ils reçoivent du lait de lactarium le temps que la lactation de leur propre mère se mette en route ou lorsque la maman ne peut pas ou ne souhaite pas allaiter. Cela leur permet de bénéficier des bienfaits de l'allaitement.

90% des bébés recevant les dons de lait sont des bébés prématurés, le restant sont des bébés hospitalisés pour des pathologies graves du système digestif [3].

Quand l’enfant n’est pas encore en capacité de coordonner sa succion/ déglutition/respiration, le lait est donné par la sonde naso-gastrique avec possibilité de quelques gouttes dans la bouche si celui-ci est réveillé.

Did you know?

90% des bébés recevant les dons de lait sont des bébés prématurés, le restant sont des bébés hospitalisés pour des pathologies graves du système digestif.

What are the benefits of breast milk?

Breast milk facilitates tolerance of tube feeding, as it improves intestinal motility. It supports the development of the digestive tract.

It is also better suited to the digestive and absorption functions of premature infants: lactose digestion is facilitated, and unpasteurised breast milk contains a lipase that improves the fat absorption coefficient.

Breast milk also helps protect against certain specific and potentially serious complications related to prematurity, such as bacterial infections [4][5], retinopathy, and necrotising enterocolitis [6][7][8][9]. 

Feeding with breast milk may also reduce the risk of rehospitalisation in infants [10].

Finally, breast milk contains vascular endothelial growth factors, which may help support healthy heart development [11].

Breast milk contains many long-chain fatty acids, as well as other components such as taurine, antioxidant agents (beta-carotene, vitamin E and inositol), which may improve cognitive and visual functions.

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Several studies have confirmed better cognitive development in premature infants fed on breast milk [12][13].

A 7-year longitudinal study of 300 premature infants fed by tube with breast milk [14] showed that a predominantly breast milk diet during the first 28 days of life was associated with better brain development, a higher IQ, better memory and better motor development.

How to donate your milk?

Who can donate their milk?

Any woman who is breastfeeding and wishes to donate her milk can do so! The conditions for donation (minimum quantities, frequency of collections, age of the breastfed baby, etc.) vary depending on the centre.

Where can I find a milk bank in France?

There are 20 external-use milk banks in France. There are also internal-use milk banks, which exclusively handle personalised milk donations collected by a mother for her own child.

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Milk donation

What quality controls are in place?

However, certain rules must be observed, such as: not smoking, not drinking alcohol, etc.

An interview and a medical questionnaire to be completed by the doctor who monitored my pregnancy, to check for certain risk factors (smoking, regular use of certain toxic medications…) that are incompatible with milk donation.

A serological screening is carried out at the first donation from a blood sample, and renewed every 3 months for the duration of the donation (HIV, Hepatitis B, Hepatitis C, HTLV) [15]

What steps should I follow when collecting my milk?

I must also follow simple hygiene measures (a guarantee of safety for the newborns who will receive the milk).

Before each collection, wash your hands and breasts thoroughly with an unscented soap, then dry your skin with a disposable paper towel.

All equipment used for collection (collection bottles, flanges and tubing, breast shells, breast pump) must be systematically degreased with washing-up liquid and then sterilised. Collection bottles are already sterilised.

Once the collection is complete, the milk must be transferred into a bottle. This can be kept in the fridge for 24 hours and you can combine milk from several collections in the same bottle throughout the day.

The milk must be cooled under cold running water, then placed in the coldest part of the fridge at +4°C.

At the end of the day, the bottle must be stored in the freezer at -18°C.

In conclusion

[1] Lactarium et circuit du lait, 2018

[2] Lactarium et circuit du lait, 2018

[3] Lactarium Ile de France

[4] De Silva A, Jones PW, Spencer SA. Does human milk reduce infection rates in preterm infants? Arch Dis Child Fetal Neonatal Ed. 2004;89:F509-13. 10.1136/adc.2003.045682

[5] Ronnestad A, Abrahamsen TG, Medbo S, Reigstad H, Lossius K, Kaaresen PI, Egeland T, Engelund IE, Polit C, Irgens LM, Markestad T. Late-onset septicemia in a Norvegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics. 2005;115:269-76.

[6] Boyd CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and metaanalysis. Arch Dis Child Fetal Neonatal Ed. 2007;92(3):F169-75. 10.1136/adc.2005.089490    

[7] Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula. 10.1038/pr.2015.218    

[8] Boyd CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2007;92(3):F169-75. 10.1136/adc.2005.08949

[9] Quigley MA, Henderson G, Anthony MY, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2007;(4):CD002971.

[10] Vohr RB, Poindexter BB, Dusick AM, et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007 ; 120 : e953-e959        10.1542/peds.2006-3227    

[11] Lewandowski AJ et al., Breast milk consumption in preterm neonates and cardiac shape in adulthood. Pediatrics 2016 ; 138(1) : e20160050. 10.1542/peds.2016-0050    

[12] Rozé J-C, Darmaun D, Boquien C-Y, et al. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open 2012;2:e000834. 10.1136/bmjopen-2012-000834    

[13] Vohr RB, Poindexter BB, Dusick AM, et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007 ; 120 : e953-e959

[14] Mandy B. Belfort et al., Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation, The Journal of pediatrics 2016 ; 177 : 133–139.e1. 10.1016/j.jpeds.2016.06.045    

[15] Association des lactariums de France : https://association-des-lactariums-de-france.fr/

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