Thread by @DrNShenker

Nearly a year since the UK's first lockdown when life became... busy.

A pandemic 40 years ago effectively ended human milk banking in the UK for most hospitals. Although no cases of HIV being transmitted through donor milk were recorded, they were deemed too ££ to maintain. 🧵/

Milk banks in the UK now operate according to the @NICEComms Clinical Guideline, specifically developed to limit risk from existing infections that can enter human milk, but also to prevent future pathogens becoming a safety concern.

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As we all know, new infections are constantly entering our lives. All milk bank processes, from how donors are screened, how milk is collected, stored, and processed, is considered in this guideline. It's a fun read, and only 134 pages long...🤩

nice.org.uk/guidance/cg93 3/

But when #COVID19 struck, there were a great many uncertainties, and some countries chose to temporarily stop using donor milk until more safety data was available. Fortunately the UK was not one of them, but women were often separated from their babies.

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Fortunately, unlike the 1980s, data came quickly showing that heat treatment destroyed SARS-CoV-2 when it was spiked into milk + that it was highly unlikely that any virus that got into the milk was actually infectious.

bit.ly/2Oo1hUC and bit.ly/30hl4Ys

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So, milk bank practices were rapidly viewed as safe, and in fact many including @heartsmilkbank expanded as research interest in human milk antibodies and other immune responses against #COVID19 grew.

bit.ly/3sTzz0G

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But most worrying last year was the practice of separating women with suspected infections from babies. I cowrote a rapid review with Prof @maryrenfrew summarising the evidence that this was a poor idea for any number of reasons...

bit.ly/2OoqaQ3

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...and this week, a team from the #WHO published modelling data on the impact of separating mothers from their infants.

Starkly, "the number of infant deaths in low-income and middle-income countries due to COVID-19 (2020–21) might range between 1800 and 2800..."

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"...By contrast, if mothers with confirmed SARS-CoV-2 infection are recommended to separate from their newborn babies and avoid or stop breastfeeding, additional deaths among infants would range between 188 000 and 273 000."

Full paper here: bit.ly/3bjpGDR 9/

So, it's been quite the ride navigating an orphan clinical service with potential risks to the team, donors, and recipients through a pandemic, but incredibly proud of what was achieved. Milk banks are too important for #nicu babies for uncertainties to persist, which...

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...is why the new Global Alliance of milk banks called for greater investment in emergency response preparedness (@LancetChildAdol). Beyond that, milk banks can provide lactation support and could actually produce therapies against future pandemics.

bit.ly/3uRaXHM
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