Donor Human Milk During COVID-19: Is it Safe?

Is Donor Human Milk Safe from COVID-19?

We have all thought about it and heard from others looking for answers to this question.  COVID-19 has healthcare professionals looking at everything in a new light because a new virus is now part of our lives and, if infected, in our bodies. 

The quick “yes or no” answer to this question is yes, it is safe.  As of this publication date, there has been no change in the recommendations on donor milk from the Human Milk Banking Association of North America - HMBANA.  They believe that donor human milk is safe to use and recommend its continued use.  HMBANA also has new screening questions for donors and other cleaning recommendations on their website.

Even though researchers have seen no documented cases, as of this writing, of an infant contracting COVID-19 from consuming infected breast milk, the question still remains if there is potential for transmission in donor human milk. A recent study from University of California San Diego School of Medicine and University of California Los Angeles worked together to see if there was COVID-19 transmission in breast milk.  The researchers examined 64 samples of breast milk collected from Mommy’s Milk Human Milk Research Biorepository from 18 women across the US infected with severe COVID-19.  One sample tested positive for viral RNS, but the virus was unable to replicate and unable to cause infection in the breastfed infant.  The researchers also mimicked the Holder pasteurization process that is usually used in human milk banks by adding COVID-19 to breast milk samples from donors who were not infected.  (Samples were heated to 62.5 degrees C for 30 min and cooled to 4 degrees C).  Following that pasteurization process neither sample had infectious virus.  The researchers recognized that this was a positive outcome for donor milk that so many infants depend upon, but they recognized that more studies with larger samples were needed for additional confirmation. 

Donor milk remains needed and screening processes, along with ongoing research, are all showing it to be safe.  But that leads to the second question:

Do We Have a Donor Human Milk Shortage?

A milk bank relies on volunteers to use breast pumps, express breast milk, and donate to a milk bank that will provide safe, pasteurized human milk to fragile and vulnerable hospitalized neonates.  Some milk banks/hospitals are preparing for a potential shortage due to fears from COVID-19.  A review of media stories on a donor milk shortage does not bring up any large concerns about shortage but some regional donor milk banks are asking for more donations and describing how the process of donating is completely safe in an effort to reassure mothers who may have concerns. 

Pasteurized donor milk is a vital resource for NICU infants when mothers cannot provide breast milk. But donor supplies have become a concern as more US cities and states issue stay-at-home orders and cases of the virus rise across the country with the fall surge of COVID-19 cases we are currently seeing at the end of 2020. Many drop-off sites are in hospitals that do not allow visitors, and blood draws for screening potential donors are being done in some places by sending phlebotomists to homes.  Other worries are that moms might not be able to transport the milk in a timely manner or they may not want to leave home to drop milk off.  Issues that are also discussed are that anxiety surrounding the pandemic can decrease milk production and moms might fear not having enough for their own child.  Therefore, it is completely understandable to anticipate that donations to milk banks could decline and it is also reasonable to prepare or have a plan in place in case of need.  Some NICUs are talking about limiting donor milk to a specific set of the most vulnerable infants and using donor milk for specific low weight or gestation limits if needed. 

Right now, it appears that some shortages are appearing in pockets across the country and it is not at all widespread.  Having a “Plan B” in place during this pandemic would be wise while carefully monitoring your supply and discussing plans, supplies, and contingencies with your regional milk bank. 

Please use the links and research below to assist in your own search and plans for donor milk use in your facility.

References

Links to research and regulatory agencies on donor milk and COVID-19:

HMBANA Special Page on COVID-19 - Milk Banking and COVID-19 (hmbana.org)

World Health Organization on COVID-19 and Breastfeeding - Coronavirus disease (COVID-19): Breastfeeding (who.int)

Journal of Lactation, March 2020, International Perspectives Concerning Donor Milk Banking During the SARS-CoV2 (COVID-19) Pandemic - International Perspectives Concerning Donor Milk Banking During the SARS-CoV-2 (COVID-19) Pandemic - Kathleen A. Marinelli, 2020 (sagepub.com)

Science Daily, August 2020, Pasteurization inactivates COVID-19 in Human Milk: New Research, Pasteurization inactivates COVID-19 virus in human milk: new research -- ScienceDaily

UC San Diego Health, August 19,2020, Michelle Brubaker,  Is COVID-19 Transmitted Through Breast Milk? Study Suggests Not Likely (ucsd.edu).  (Study published in online JAMA)

Links to articles/research on donor milk shortage:

US NICUs and donor milk banks brace for COVID-19 - The Lancet Child & Adolescent Health

University of California Health launches human donor milk bank to help newborns | UCnet

Citing 'immediate need,' Erlanger calls for breast milk donors | WTVC (newschannel9.com)