Tokyo hospital's breast milk bank a lifeline for vulnerable infants

Japan’s only breast milk bank is a freezer at Showa University’s Koto Toyosu Hospital.

Launched last year, the facility in Tokyo’s Koto Ward stores pasteurized breast milk in small containers.

It offers essential nutrients and protections for vulnerable infants, particularly those born prematurely or underweight.

“About 16 mothers provided their breast milk for free over the past year,” said Katsumi Mizuno, a professor of pediatric internal medicine at the hospital, who opened the bank in September 2014.

The milk was given to 19 premature babies at the hospital’s Neonatal Intensive Care Unit (NICU). The hospital currently only accepts milk from and gives it to its own patients.

Breast milk is known to help prevent premature newborns from contracting some diseases, but there is also the possibility of infection from the milk itself — the reason such banks have not spread in Japan, although they have appeared overseas.

As a member of a research team on the issue at the Ministry of Health, Labor and Welfare, Mizuno is studying operational issues surrounding the breast milk bank system and hopes to expand it in the future.

He says breast milk lowers the risk of babies contracting necrotizing enteritis, the death of tissue in the intestine often seen in premature babies.

This fatal disease is caused by lack of blood flow in the intestines. The risk is thought to be higher in babies that weigh less than 1,500 grams at birth.

To lower the risk, babies need breast milk, which is easy to digest and is rich with antibodies. Some mothers, however, cannot provide breast milk due to reasons such as illness.

In the past, NICUs nationwide used breast milk provided by other mothers. However, fewer are now doing this amid concerns over infection, according to Kikuko Oku, a veteran pediatrician familiar with the science of breast milk, citing surveys. Some hospitals even ban donated breast milk, she said.

But another doctor at a university hospital disagrees with banning the practice.

“There are babies whose conditions could actually improve if they are fed breast milk, so we can’t ban it completely,” the doctor said.

In fact, when Mizuno’s group queried NICUs across the country, 32 out of 126 facilities, or 25 percent, said they still feed babies breast milk from other mothers at their hospitals.

In prenatal care, expectant mothers are checked for HIV, hepatitis and T-cell leukemia virus, and many hospitals re-examine the donor before they receive the milk. But there are no criteria at present to ensure the safety of breast milk provided by surrogate mothers.

Meanwhile, the number of newborns weighing less than 2,500 grams is increasing, and there has also been a slight rise in those weighing under 1,500 grams, categorized as very low birth-weight infants. Around 8,000 of the latter are born every year, health ministry figures show.

“Newborns who contract necrotizing enteritis (account for) about 1.6 percent of the very low birth-weight infants, but that’s still over 100 babies every year,” Mizuno said. “If we could create a system that could offer a steady flow of safe breast milk, we may be able to save at least some of them.”

Brazil and some nations in Europe and North America have introduced breast milk banks.

When registering donors for the bank, Mizuno adopted the criteria used in North America: nonsmokers who passed a number of virus tests and whose families have a clean bill of health.

Milk is pasteurized in special equipment and stored with the donor’s data, which will be retained until the child reaches the age of 21.

The existence of such facilities is expected to spread, but Mizuno worries about the increased workload involved. The exams and paperwork are additional to the service’s basic function and represent a significant added burden.

“I’m not sure individual hospitals can handle (this),” said Mizuno.

Meanwhile, if the work is entrusted to just one dedicated facility, the safe transport of pasteurized breast milk to where it is needed nationwide would be an issue.

“We need a system to provide safe milk (for) premature newborns, ” said Satoshi Kusuda, president of Japan’s Society for Neonatal Health and Development and a professor at Tokyo Women’s Medical University.

“But before we consider creating a large bank, it is more realistic to learn from Showa University’s experience, and decide what steps are necessary to ensure the safety of breast milk banks.”