Human Milk Bank Processes:
Human Milk Bank System in Brazil
Sergio Duarte Segall, Ph.D
Path Consultant in Brazil
+55 31 3022-4664
+55 31 9134-8886
sergiosegall@yahoo.com
Background info
Brief description
1940
IFF
(Instituto Fernandes
Figueira)
The Human Milk Bank of the Instituto Fernandes Figueira
has a direct relationship with the directions of the history of
Human Milk Banks in Brazil. By being the first unit in
operation between 40's and 70 it served as model
institutions, replicating the proposal to operate exclusively
with the collection and distribution of milk human, without
developing promotional activities, protection and support
breastfeeding.
From 1943 to 1985, the main problem was the need to
increase the volume of milk collected. The search for an
effective program that allows to expand the collection was
always the subject of major concern.
With the development of the National Program for
Encouraging Breastfeeding - PNIAM in 1981 in Brazil, it was
observed social mobilization in favor of using human milk,
which culminated in a kind of stimulus the deployment of
Milk Banks, with the objective of promoting the service in
times of urgency, for infants unable to be clinically directly
Page 2
breastfed by their mothers.
Financial support
Brief description
The Compromises of MOH with RNBLH are:
State and Municipal
governments
1 - Expanding the Network of Human Milk Banks
National Council for
Scientific and
Technological
Development (CNPq)
3 - Implementation Phase II of the National Quality Program
in Human Milk Bank - PNQBLH
Ministry of Health
2 - Updating the information system
4 – Boost the HMB into the SUS – National Health Service
belongs to the MOH
5 - Revisit the National Commission on Human Milk Banks CNBLH
6 - Supporting the State Commissions of Human Milk Banks CEBLH and the State Reference Centers
7 - Create the Latin American Network of Human Milk Banks
8 – Coordinate the National Campaigns like the NATIONAL
DAY OF DONATION OF BREAST MILK.
Page 3
Brazilian HMB in numbers
Brief description
ANVISA
(Regulated Agency)
In Brazil, all human milk given to babies of women
that is not the biological mother should be processed
according to standard operating of human milk banks
- RDC / Anvisa No. 171/2006 .
In 2011 Brazil achieved the total of the211 HMB and
114 PCLH (Milk collect post) in all Brazilian states.
These PCLH collect the milk and send it to the HMB to
be processed.
The many of these HMB are collocated in hospitals to
offer the milk to Neonatal units.
In 2011 the Brazilian HMB collected 168,054 L from
160,022 donors. The volume distributed (129,342)
attended 160.666 receptors
Page 4
State
Group Care
Distrito
73.783
Goiás
6.950
Mato Grosso
832
Mato G do Sul 8.395
Alagoas
17.438
Bahia
11.082
Ceará
7.669
Maranhão
5.805
Paraíba
10.899
Pernambuco
8.665
Piauí
1.191
Rio G do Norte 9.140
Sergipe
9.950
Acre
2.268
Amapá
8.679
Amazonas
10.955
Pará
4.847
Rondônia
3.776
Roraima
7.127
Tocantins
3.628
Espírito Santo
2.622
Minas Gerais
8.039
Rio de Janeiro
9.560
São Paulo
58.318
Paraná
11.480
Rio G do Sul
5.501
Santa Catarina 13.065
Individual Care
161.308
21.713
5.103
27.780
18.337
26.274
18.809
22.234
65.209
156.544
1.544
20.479
16.718
17.145
16.990
3.478
26.834
22.520
8.470
19.050
17.821
42.183
107.206
265.933
15.368
53.439
55.900
Home visit
29.475
4.798
894
8.831
2.970
8.382
1.548
4.237
8.565
1.682
5.745
4.519
2.573
616
3.162
3.838
15.054
2.245
1.234
3.351
2.324
17.426
6.131
60.823
22.440
604
7.526
Page 5
National and Regional Reference Centers Organogram
Teaching Center
Laboratory of Quality Control
Firefighters Program
IT Cluster
Chief of
Reference
Center
R&D Center
Donor Assistance
Production Service – HM
Program for Tech Development
Transport of Milk
• The health professional that attend the women in hospital advised
the women to seek the milk bank by a toll free number (1-800) where
women report that they want to donate the milk.
• The milk home collection is done through civil defense or fire stations
in partnership with milk bank that goes to the home of donors who
can not come to the hospital. The milk is transported in isothermal
boxes with ice frozen out and arrives frozen in milk bank.
Figure 2 shows the car used for civil
defense to visit the home donors and
collect the frozen human milk.
Figure 3 - Isothermal boxes used in
the process of collection and
transportation of breast milk
Who can Receive the Donated Milk
1 - Distribution
• Distribution of human milk to a receiver is conditional upon:
a) the prescription or requesting physician or nutritionist containing
volume / daily schedule and needs of the recipient;
b) meeting the following priority criteria:
b.1) newborn premature or low birth weight that does not suck;
infected newborn, especially with enteroinfections;
b.2) newborn nutrition trophic;
b.3) newborn suffering from immunodeficiency;
b.4) newborn suffering from allergies heterologous proteins, and
exceptional cases, the medical criteria.
Pasteurization
• LTLT (62 oC for 30
minutes)
• If the acidity is higher
than 8 degrees Dornic
the milk is discarded
and can not be used
for infant feeding.
Figura 4 - Water Bath for pasteurization process
Figura 5 - Creamatocrit and small titrator used to calculate the fat content
and Dornic acidity, respectively.
Equipment/Location
• All the human milk banks follow the modus operandi and the quality
standard set by Fiocruz.
• The reference center cost around US$ 50K
Figure 6 – Quality control laboratory of the HMB
Table 1 – Quality control laboratory of the HMB
11