The Human Milk Bank Services are fundamental structures to support health care and contribute to increasing the survival of children from different social classes. According to the World Health Organization (WHO), Brazil has the largest and most complex network of human milk banks in the world, and is a model for international cooperation in more than 20 countries in the Americas, Europe and Africa, established through the “Brazilian Cooperation Agency” (ABC).
The Brazilian model is recognized worldwide for its unprecedented technological development, which combines low cost with high quality, in addition to distributing human milk according to the specific needs of each baby, increasing the effectiveness of the initiative to reduce neonatal mortality.
With the new Coronavirus pandemic (SARS-CoV-2), home collection of breast milk has dropped by 35% across the country. The Ministry of Health clarifies that so far there is no scientific evidence to prove the transmission of the coronavirus through breastfeeding.
Despite the moment of great tension to public health, strict safety measures are necessary for the human milk management, thus avoiding that external factors may contribute to jeopardize the safety of the processing of the entire human milk cycle.
The following are measures that can contribute to the safety of this process.
Measures to Control the Care Environment in Human Milk Collection and Management Services
- Equipment for shared use between people (for example, extraction pumps) must be cleaned and disinfected after use;
- Properly sanitize your hands, respecting their five moments as indicated by the World Health Organization;
- Apply standard or additional precautions as suspected or confirmed by diagnosis;
- Perform the milking of human milk in a private place, avoiding the procedure in collective rooms, whenever possible;
- Establish hygiene measures for collective contact places such as raw milk refrigerators and seats for milking or breastfeeding;
- Provide a surgical mask to the person suspected of being infected with the new coronavirus, or person who has or had contact with the suspected or confirmed case;
- Properly dispose of waste, according to Anvisa’s technical regulations for waste management of health services.
Safety Measures for Breastfeeding Women with Suspected or Confirmed Cases of COVID-19
The World Health Organization (WHO) guides the maintenance of breastfeeding, since so far we have no evidence that breast milk can transmit the new coronavirus. The “Department of Strategic Programmatic Actions of the Secretariat of Primary Health Care” (Dapes / Saps) of the Ministry of Health, in partnership with other entities, drew up a technical note, which makes recommendations for breastfeeding in eventual contexts of transmission of influenza syndromes.
Thus, considering the benefits of breastfeeding for the health of children and women, and the absence of scientific evidence about the transmissibility of the virus through breastfeeding, there is no recommendation to stop breastfeeding.
If the woman feels insecure about breastfeeding in confirmed cases of COVID-19, she can perform the milking of her milk and offer it to the child. These are recommendations for the nursing mother, considering the risk of transmissibility to the child:
- Wash your hands before touching the baby or before expressing breast milk (by hand or by the pump);
- Wear a face mask (completely covering the nose and mouth) during feedings and avoid talking or coughing while breastfeeding (The mask should be changed immediately in case of coughing or sneezing, and with each feeding);
- Strictly follow the recommendations for cleaning the breast pumps after each use;
- The possibility of asking for help from someone who is healthy to offer breast milk to the baby should be considered;
- It is necessary that the person who offers breast milk to the baby learns to do this with the help of a health professional.
Human Milk Collection in Hospital and Extra-Hospital Environment
The collection of human milk in a hospital environment should be performed, whenever possible, under the supervision of a health professional, respecting hygiene issues and providing basic guidelines as usual. It is necessary that the milking room be prepared for the least possible handling of utensils in the environment and be able to offer a surgical mask and a disposable cap for milking. If it is necessary to use mechanical extractors, cleaning the equipment requires special care for its disinfection, according to institutional standards.
For the collection of extra-hospital human milk, the safety rules remain the same, as long as the woman or family member of the same residence does not present respiratory symptoms.
Safety in Storage and Transport of Human Milk
The process of storage and transport of human milk must first comply with current legislation and must be carried out by a structure exclusively intended for this purpose. Precautions to prevent milk contamination should be reinforced with the following actions:
- Hand sanitize whenever the environment is touched, the sterile or disinfected container and the extraction pump;
- Keep human milk stored at up to 5 degrees and administer within 12 hours (In the case of frozen samples keep at -3 degrees and administer within 15 days).
All the measures exposed were based on the evidence available at the time and may be changed in the face of new evidence. It is recommended that additional strategies be based on epidemiological information periodically released by federal, state or municipal authorities.
- Martins, A. Medo do coronavírus provoca queda na doação de leite materno. Secretaria da Saúde do Distrito Federal, 31 de março de 2020. Disponível em:http://www.saude.df.gov.br/
- medo-do-coronavirus-provoca-queda-na-doacao-de-leite-materno. Acesso em 04 de abril de 2020.
- Ministério da Saúde (MS). Bases para discussão da política nacional de promoção, proteção e apoio ao aleitamento materno. Brasília: Editora do Ministério da Saúde; 2017.
- Ministério da Saúde. Doação de leite: o que é aleitamento materno, importância, como doar. Disponível em: https://www.saude.gov.br/saude-de-a-z/doacao-de-leite. Acesso em 04 de abril de 2020.
- Palmeira P, Costa-Carvalho BT, Arslanian C, Pontes GN, Nagao AT, Carneiro-Sampaio MM. Transfer of antibodies across the placenta and in breast milk from mothers on intravenous immunoglobulin. Pediatr Allergy Immunol 2009; 20(6):528-35.
- Victora CG , Bahl R, Ramos AJD, França GVA, Horton S, Krasevek J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387(10017):475-90.
- Sociedade Brasileira de Pediatria – nota de alerta – O aleitamento materno nos tempos de COVID-19. Março de 2020.