SINGAPORE: The premature delivery of his twin daughters at 30 weeks in February came as a shock to Louis Ng and his wife, Amy. Mr Ng, who is a Member of Parliament for Nee Soon GRC, said the last month has been an emotional struggle for his family, as they grapple with the twins' various health issues.
Fortunately, expressing breast milk for them has not been a problem for Mr Ng’s wife, even though many mothers of premature newborns and other sick babies face challenges with their milk supply. “But sometimes when she is really stressed and nothing comes out, that’s when I can see how scary it is for other mothers who are probably stressed with their preterm babies,” he said.
“Some of the babies there (in the neonatal intensive care unit at Singapore General Hospital) are even smaller than mine. And I can imagine the amount of trauma the parents are going through.”
MILK BANK: A TIMELY INITIATIVE IN SINGAPORE
For mothers facing challenges in breastfeeding their premature or sick infants, the possibility that Singapore could get its first human milk bank may come as some reassurance. Responding to queries, Temasek Foundation Cares,the philanthropic arm of state investment company Temasek,confirmed it is partnering the KK Women’s and Children’s Hospital (KKH) on such a programme, but it said it could not provide details as the initiative is still at an early stage. Meanwhile, in response to a question about whether it is starting a milk bank, KKH said it is "working on a project" but that it is too soon to provide more information.
Milk banks typically work by first screening donor mothers for diseases such as HIV, Hepatitis B and C as well as syphilis and other diseases. The donated breast milk would also be pasteurised to prevent contamination, and stored in safe conditions.
Paediatrician and neonatologist with SBCC Baby and Child Clinic, Dr Natalie Epton said donors for such a programme would typically be mums who are feeding a child under six months. “(She would be a mother of) a child who has not yet started on solid foods where the milk is still at that level of immaturity that is similar to that of a newborn,” she said.
Dr Epton said the donor should also not be a smoker and should not drink more than two units of alcohol a day. She should also have a milk supply “over and above” the needs of her infant.
According to the International Milk Banking Initiative (IMBI), about 37 countries operate milk banks, in places such as Canada, US and Europe. The UK has at least 16. IMBI said most of these milk banks provide breast milk exclusively to hospitalised babies.
HUMAN BREAST MILK: A CRITICAL SOURCE OF NUTRITION FOR PREMATURE BABIES
Guidelines by the World Health Organization (WHO) recommend mothers exclusively breast feed their babies for the first six months. “Breast milk contains multiple anti-inflammatory, anti-infectious agents, hormones, various chemicals that are protective to the gut and help protect against infections,” Dr Epton said. “These are specific to human breast milk and cannot be mimicked by formula.”
Dr Epton said breast milk is critical for premature babies, who are at risk of being infected with a serious disease known as necrotising enterocolitis (NEC).
“Ninety per cent of babies who get NEC are premature,” she said. “It’s a disease of an immature gut that becomes inflamed, infected and then parts of the bowel may actually die. This occurs much more frequently in babies who have had formula (milk). It’s almost unheard of in babies who have been fed breast milk.”
But for mothers of premature babies, Dr Epton said it might take days or weeks before their bodies are able to produce sufficient milk, as they themselves might be sick or physically drained from having delivered a premature baby.
A milk bank could fill the gap during the critical period until the mother’s milk supply recovers.
COST-SAVINGS FROM RUNNING MILK BANKS: REPORT
Dr Epton said milk bank numbers around the world continue to rise, after a dip in the 1980s due to the emergence of diseases such as HIV. But with “rigorous screening methodologies” and the need for proper and safe storage, she acknowledged that they are expensive to run. Still, she said the cost-savings would more than compensate.
A report by the Australian Health Department in 2014 highlighted that it could cost as much as S$260,000 each year to run a milk bank in Australia. The bank could also need just as much to operate each year.
But the report also suggested that Australia spent about S$27 million in 2010 on hospital costs associated with about 180 cases of NEC. Of these cases, 103 needed surgery.
The report said if half of those cases could have been prevented by feeding donor breast milk, the Australian hospital system could see savings of up to S$14 million a year. “This is without taking into consideration the longer term health consequences and costs associated with NEC, or the costs of other conditions for which breast milk has a protective effect,” it said.
SHOULD MILK BANKS CATER TO HEALTHY BABIES AS INFORMAL SOURCES RISE
With no official milk banks in Singapore, and an increased awareness of the benefits of breastfeeding children, mothers who cannot do so for a variety of reasons are turning to informal milk sharing platforms. One of them is Human Milk for Human Babies-Singapore, a Facebook page dedicated to helping mothers seeking and donating breast milk. On the page, mothers seeking milk for the babies can put up a request, while donor mums list the amount of breast milk they are able to donate, as well as information such as their general health and the type of supplements they take.
The page has more than 5,000 likes and its administrator, Khatim Hamidon, said the page works via informed consent - donor mums are encouraged to be as open and transparent about their health as possible, while recipient mums are supposed to ask as many questions to ensure they are ruling out any doubts on the safety of the milk.
“In the end, the donor mums are also giving the same milk to their own babies, so there is also that reassurance,” Ms Khatim said.
Dr Epton said while babies have received donor milk “since the dawn of time” from sources such as wet nurses and other family members, receiving unscreened donor milk from strangers still poses a risk.
Mr Ng said that some of his friends who have gone through this route have concerns at the back of their minds. “With parents there is always that worry of whether you’re doing what is right for your child and the worry if the mother was a smoker, if there are any illnesses and whether the milk expressed is healthy for your kid,” he said.
Mr Ng suggested while priority should be given to preterm and sick babies, the milk bank could extend the programme to other babies if there is an over-supply. He gave the example of nurses having thrown away three bottles of milk his wife had pumped for the twins earlier, as it had expired.
"It’s almost painful. But that’s the protocol - throw it away but if we can share then that will be the best," he said.
"So the milk bank is crucial for some mothers and probably my wife will be the first to donate to this."