for the medical community

Three Rivers Mothers’ Milk Bank opened its doors in January 2016 to ensure that hospitals and outpatients in Pennsylvania and the Mid Atlantic States have a reliable, abundant, safe supply of donor milk.

Breastmilk Benefits

Better Outcomes

An all human milk diet is highly protective against the most common and devastating complications in the neonatal intensive care unit. Complications that can increase lengths of stay, cause long term disability, or even death.

Most notably, the use of donor milk to achieve an all human milk diet can significantly reduce rates of necrotizing enterocolitis (NEC) in at risk infants (Boyd 2007, Ganapathy 2012, Katorowska 2016, Meinzen-Derr 2009). This reduction may be quite substantial reaching levels near 80 % (Colaizy 2016, Cristifalo 2013). It is estimated that for every 18.5 vulnerable infants fed a human milk diet, one is saved from necrotizing enterocolitis (Boyd 2007). Those infants who acquire NEC despite an all human milk diet have a shorter, more benign course and rarely require surgery.

In addition to protection from NEC, the use of donor milk has been shown to reduce the incidence of various infections, decrease the total number of days of parenteral nutrition (TPN), decrease rates of retinopathy of prematurity, and reduce the length of stay in the NICU (Boyd 2007, Cristofalo 2013, Schanler 2005, 2006)

Increased Breastfeeding Rates

For a variety of reasons, many mothers with infants in the NICU setting struggle with providing enough milk for their infants despite adequate lactation support and education.

The very best nutrition for an infant is mother’s own milk with very rare exceptions. Donor milk is never used as a substitute for mother’s milk and is intended as a support to breastfeeding.

The use of donor milk when supplementation is necessary is associated with a significant increase in the consumption of mother’s own milk and exclusive breastfeeding upon discharge (Arslanoglus 2012, Kantorowska 2016).

This effect can be quite dramatic after the introduction of donor milk to a unit. After two years of donor milk use, a level 3 NICU in the US recently reported a 6-fold increased odds of the consumption of mother’s own milk in VLBW infants receiving donor milk (Parker 2016). The same unit also reported a 49% reduction in the cessation of maternal milk consumption during hospitalization.

Donor milk can also be an inexpensive yet powerful breastfeeding promoter and patient satisfier in the well newborn nursery too.

Decreased Healthcare Costs

While babies requiring a stay in the NICU are a fraction of the patient population, their care represents a disproportionately large burden in terms of health care dollars. Diagnoses such as NEC are some of the most expensive for both hospitals and insurers.

On average, a case of medical NEC results in $74,004 of additional care and one case of surgical NEC adds $198,040 to the cost of care. It is estimated that $8,167 is saved per NICU infant receiving an exclusive human milk diet (Ganapathy 2012).

It is estimated that for every $1 spent on donor milk $11 to $38 could be saved in health care costs. This includes, among other things, NEC, feeding intolerance, and infection (Wight 2001).

A retrospective analysis concluded that an exclusive human milk diet reduces total hospitalization costs by $106,968 per VLBW infant (Assad 2016).

A recent study estimated the national annual burden of suboptimal human milk feeding of just extremely low birth weight babies is $27.1 million of direct medical costs and $1.5 billion in costs attributable to premature death (Colaizy, 2016).

A Safe, Effective Choice

Accredited by HMBANA

Three Rivers Mothers’ Milk Bank is a member of The Human Milk Banking Association of North America HMBANA) and as such strictly follows its guidelines for donor screening, milk processing, and distribution.

The evidence based protocols used by HMBANA have an exceptional safety record with no documented cases of an ill effect to a recipient of HMBANA processed milk in its 30 year history.

Multiple Layers of Safety

Multiple, overlapping layers of safety are employed due to the vulnerable infants that we serve. Donors participate in a verbal interview that includes questions about risk factors for blood borne illnesses and medication use, complete a detailed written medical history, statements of health are obtained from the health care providers of both the donor and her baby, donors submit to a blood test and collected milk is pasteurized in a process that effectively destroys pathogens.

Every HMBANA milk bank uses the Holder Method of Pasteurization (62.5°C for 30 minutes) to eliminate pathogens while maintaining as many bioactive components as possible. This small batch, low heat pasteurization is the preferred method of processing milk as it maintains the majority of lysozyme and Secretory IgA activity and other important properties that support the immune systems of vulnerable infants. Methods that use high heat essentially sterilize the milk, destroying all activity of these essential components.

A random bottle from each processed batch is cultured. Pasteurized milk that shows any growth is discarded or offered for research.

The Support of a Panel of Experts

In additional to our Medical Director, staff have access to our Medical Advisory Board and the clinicians of our Board of Directors. This panel of experts that include neonatologists, infectious disease specialists, pediatricians, pharmacists, nurses, and lactation consultants are available to develop protocols and address specific clinical issues.

An Open Door Policy

Three Rivers Mothers’ Milk Bank has an open door policy for all clinicians and families. You are welcome to tour our facility at any time. We are also available to answer questions or to arrange a webinar or inservice for your staff.

Want to know a little more? Check out our How it Works page for more information.

Hospital Ordering Information

If your institution is interested in using donor milk from Three Rivers Mothers’ Milk Bank please contact us at orders@threeriversmilkbank.org or 412.281.4400 to set up an account.

Milk is available in 200ml, 100ml, and 50ml bottles.
Premature milk is processed separately when available.
Our frozen milk is transported by courier to facilities within the Greater Pittsburgh area.

For those facilities that are outside of Pittsburgh, milk is shipped overnight using Fedex and a perishable item shipping logistics company. Dry ice is used to ensure that milk arrives solidly frozen.

Outpatient Use and Ordering

Infants outside of the hospital setting can benefit from donor milk too.

Common diagnoses include:

  • cardiac conditions
  • immune disorders
  • inborn errors of metabolism
  • intolerance of formula
  • malabsorption disorders
  • post-surgical nutrition
  • prematurity
  • renal disease
  • bronchopulmonary dysplasia
  • spinal muscular atrophy type II
  • short gut syndrome
  • failure to thrive
  • organ transplantation
  • neonatal abstinence syndrome

Prescribing Donor Milk

All outpatient orders require a signed prescription from a health care provider with prescriptive authority who is providing medical care to the recipient. Prescriptions are typically written monthly and must include the following:

  • recipient’s name
  • recipient’s date of birth
  • date of order
  • medical indication for donor milk
  • number of refills
  • number of oz/ml per week/month

Ordering Milk

Outpatients may call 412.281.4400 or email orders@threeriversmilkbank.org the milk bank to initiate the ordering of donor milk. Frozen milk is picked up at our facility in the Strip District of Pittsburgh or shipped overnight via Fedex.

Prioritization

Three Rivers Mothers’ Milk Bank relies upon the generosity of milk donors and therefore cannot guarantee availability for outpatients. Priority is given to hospitalized infants, then outpatients with medical needs, and lastly outpatients with non-medical needs such as adoption or temporary discontinuation of breastfeeding due to maternal medication. The milk bank anticipates that over 20% of it to be used by outpatients and expects to consistently and adequately fulfill the requirements of outpatients with medical needs.

Pricing

Pasteurized donor milk is sold frozen in BPA free bottles. Our processing fees are as follows:

200ml bottles                     $28.05 ($4.15/ounce)

100ml bottles                     $14.02 ($4.15/ounce)

Paying for Donor Milk

While a baby is hospitalized, the donor milk processing fee and delivery are typically billed to the hospital. If a baby is not hospitalized, the fees are billed to the family or insurance company.

Families who have private insurance are encouraged to file a claim. We are happy to work with the family, the baby’s healthcare provider, and insurance company to obtain coverage. While not yet mandated in Pennsylvania or West Virginia, Medicaid programs may cover outpatient donor milk for certain cases. If necessary, we can establish a payment plan. Three Rivers Mothers’ Milk Bank also has a free care fund to assist families with the cost of donor milk.

We ask that prescribing health care providers contact the recipient’s insurance carrier to obtain pre-authorization. A letter of medical necessity is typically required.

Storing and Handling Donor Milk

Each facility must develop their own evidence based protocols for using donor milk.

We encourage facilities to order a copy of HMBANA’s publication Best Practice for Expressing, Storing, and Handling Human Milk in Hospitals, Homes, and Child Care Settings.

Please keep these points from HMBANA’s best practices in mind:

  • Frozen or pasteurized human milk has slightly decreased bacterial inhibitory factors and requires greater precautions.
  • Donor milk should be stored frozen.
  • Frozen donor milk should be thawed in a refrigerator.
  • Bottles of donor milk can be rapidly thawed in a container of warm water. The water should not exceed 37°C and must not touch the lid. Wipe the bottle dry before placing in the refrigerator.
  • Do not microwave milk.
  • Completely thaw bottles until liquid. Just thawing enough for a single feed will result in uneven distribution of nutrients.
  • Thawed milk must be refrigerated at all times and should be used within 24 hours.
  • Gently swirl milk to distribute nutrients before feeding. Do not shake.
  • Adding anything to donor milk including human milk derived and bovine fortifiers alters storage times.

Recommending Milk Donation

Clinicians are important partners in identifying donors so that we may provide this lifesaving service. You are in the field interacting with expectant and new mothers on a daily basis.

Interested donors may contact us at donate@threeriversmilkbank.org or at 412.281.4400 to inquire about donation and to schedule an interview with one of our screening nurses.

Donors go through a four part screening process which consists of a verbal interview (by phone or in person), completion of an application packet with a detailed medical history, statements of health from the health care providers of the donor and her baby, and blood screening.

Blood screening includes tests for HIV, HTLV, Syphilis and Hepatitis B and C. Three Rivers Mothers’ Milk Bank contracts with Quest Diagnostics and CORE to ensure a convenient option for every donor.

Approved donors in the Pittsburgh area drop off frozen pumped milk to our facility in the Strip District.

Approved donors outside of the Pittsburgh area ship their milk. A Styrofoam core shipping box and packing materials along with instructions are sent to the donor. The donor contacts our perishable item shipping company to set up a time for Fedex to pick up the packed box from her home.

All screening and shipping costs are paid by the milk bank.

Donors to HMBANA milk banks are never paid as compensation introduces ethical and safety concerns.

Resources for Clinicians

SPIN (Supporting Premature Infant Nutrition) Program: This comprehensive program from UC San Diego Health has many useful resources for NICU staff including a sample donor milk consent form and feeding protocols.

The Human Milk Banking Association of North America

Educational Materials: Three Rivers Mothers’ Milk Bank offers a variety of materials including info booklets for NICU parents, brochures for outpatients, lactation support booklets for bereaved mothers, donor brochures, and posters. These are provided free of charge. Please contact us at info@threeriversmilkbank.org to request materials.

Clinician Education: Our staff welcomes the opportunity to connect with clinicians in our region and are available for inservices, webinars, and conferences.