BREASTFEEDINGIN ISLAMIC PERSPECTIVEAccordingto World Health Organization (WHO), breastfeeding is the normal way to provideyoung infants with the nutrients they need for healthy growth and development.Breast milk is recommended by WHO as the perfect food for the newborn andfeeding should start within the first hour after birth. Exclusive breastfeedingis recommended up to 6 months of age and continued along with appropriatecomplementary foods up to two years of age or beyond.

(1) In to Islamic rules,the fuqaha’ have clearly stated that breasfeeding is the right of the child asAllah has stated in Quran in surah Al Baqarah verses 233 which recommends a 2year period of lactation: (2,3)????????????????????????? ?????????????? ?????????? ??????????? ?????? ??????? ??? ??????????????????? ?????? ???????????? ???? ??????????? ????????????????????????????? ??? ????????? ?????? ?????? ????????? ??? ???????? ???????????????????? ????? ????????? ????? ?????????? ??????? ?????????? ?????? ???????????? ???????? ???????? ??? ??????? ?????????? ??????????? ????? ?????????????????? ?????? ?????????? ??? ??????????????? ????????????? ????? ????????????????? ????? ?????????? ???? ???????? ?????????????? ??????????? ?????????????????? ????? ?????? ????? ??????????? ??????? ?????And the mothers (married or divorced) should suckle their(born) children for two whole years, (that is) for those who desire to completethe term of suckling, and their nutrition and clothing must be upon the fatheraccording to custom and usage (on a reasonable basis, bi’l ma’rûf); no soulshall have a burden laid on him greater than he can bear. A mother should notbe made to suffer harm because of her child, nor should the one for him thechild was borne (the father) because of his child. And a similar devolves onthe heir. But if both desire weaning by mutual consent and counsel, there is nosin on them, and if you wish to engage a wet-nurse for your children, there isno sin on you so long as you pay what you promised for according to custom andusage (on a reasonable basis); and have piety (takwâ) towards Allah and knowthat Allah is All-Seeing of what you do. About onein eight babies are born preterm.

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Preterm infants have higher risk ofnecrotising enterocolitis if not being breastfeed.(4) They also have prematureimmune and digestive systems, therefore exposure to the cow’s milk can exposethem to feeding intolerance and potential development of necrotisingenterocolitis (NEC).(5) Necrotising enterocolitis is a condition that can causedamage to the intestine that caused by tissue death. Therefore, this human milkbank may become a help to the infants to grow and get benefit from the breastmilk. Prematureinfants have altered host defences which increase their susceptibility tonecrotising enterocolitis. They have reduced gastric proteolytic enzymes,increased gastric ph, reduced intestinal motility, increased intestinalpermeability, altered epithelial membrane tight junctions and diminished intestinalmucus coat.(6) Clinical studies with Mothers own Milk shown that there isreduction in 50% in the rate of getting necrotising enterocolitis and ashortened length of hospital stay compared to mothers own milk and formula orformula alone.

(6) STAGES OFLACTATIONStages oflactation start with colostrum which present in the first three days afterbirth, has a yellow color with thick consistency. Colostrum has higher amountin protein and low in fat and sugar. The protein is three times higher thanmature milk, because it is rich in antibodies that being passed from themother. These antibodies protect the babies and act as laxatives which help thebabies pass the first stool called meconium.(7, 8) Colostrum also rich inimmunologic components such as secretory IgA, lactoferrin, leukocytes as wellas epidermal growth factor. (9)The milkwill change and increase in quantity about 48 to 72 hours after giving birth.It can vary in and between individuals and the energy can vary between 270 and315 kJ per 100 ml.

mature milk continues to provide immune factors and othernon-nutritional components to the infant. (7, 8)Thematernal diet is not always optimal, thus, continuing multi-vitamins duringlactation is recommended. Regardless of maternal diet, Vitamin K is extremelylow in human milk and thus, the American Academy of Pediatrics recommends aninjection of this vitamin to avoid hemorrhagic disease of the newborn. VitaminD also occurs in low quantity in human milk, particularly with low maternalexposure to sunshine, a circumstance now common in populations worldwide. Whilethe impact of maternal supplementation with vitamin D on milk composition isunder investigation, current pediatric recommendations target postnatal vitaminD supplementation of breastfed infants. (9) HUMAN MILKBANKHuman milkbank or Mothers’ milk bank is a service which collect, test, processes andprovides donor human milk to the babies. Babies who receive donor human milkmay be premature or have severe illnesses and need human milk to thrive. (10)In Singapore, KK Women’s and Children’s Hospital (KKH) collaborate with TemasekFoundation Cares to launch the Breast Milk Bank on 17 August 2017.

They have putrequirement for donated milk, which are pre-term infants have to be born atless than 32 weeks of gestation, weighing 1.8kg or less at birth and at highrisk of getting necrotising enterocolitis or has been diagnosed withnecrotising enterocolitis.(12) Human milkbank also may offers solution to the mothers who cannot supply their own breastmilk to their child, for example, the mothers who have been diagnosed with aparticular health condition that can be passed to the breastfed infant such asinfected with human immunodeficiency virus (HIV).

(11) In preparing andprocessing donated human milk, Human Milk Bank Association of North America(HMBANA) has established guidelines and policies for donor human milkcollection.(13) Donor human milk must be pasteurized, stored and mixed.Singapore also adheres to strict guidelines and policies of HMBANA forscreening donors, processing and dispensing the donated human milk.(14) Collectionprocess of donor human milk **from KKHwebsite Donatedmilk should be refrigerated immediately at 4 °C in refrigerator for up to 24 hours. Raw donor milk can be storedfrozen at -20°C for up to three months. It should not be stored frozen for morethan 3 months because of lipolytic activity and loss of vitamin.(15) Once donormilk is selected for processing, the frozen milk is thawed and pooled under asterile condition. Each pool is thoroughly mixed to ensure an even distributionof human milk components.

Raw donor milk should not be refrozen after thawing.The thawed milk also should not be left at room temperature for longer than 2hours before pasteurisation.(13, 14, 16) Holder pasteurisation method is theprimary method used by HMBANA milk banks. This method is done by heating themilk at 62.5°C for 30 minutes.(13) Pasteurisation kills the viruses andbacteria that may be harmful to fragile infants while retaining majority of themilk beneficial components.(17) Bacterial culture is taken before and after thepasteurization and any milk that is culture positive for any pathogen or forgreater that 104 colony-forming units/mL of skin flora isdiscarded.(18) According to HMBANA guidelines, the pasteurised donor human milkis frozen and stored.

It can be dispensed to the recipient after the samplesare culture and show no culture/bacterial growth.(16) DONORREQUIREMENT AND SCREENINGThere aremeticulous screening and tests that a donor must undergo to donate theirmilk.(18) These screening and tests must be considered as we want to make surethat the milk are safe to be given to the infants.

According to Human Milk BankAssociation of North America, all donors undergo screening process that beginswith telephone interview. Donor must be: (19, 20, 21)-         Confident in her milk supply and produce milkin excess of her own baby’s needs –         In a good health-         Not regularly on medication or herbalsupplements-         Willing to undergo blood test to be screenedfor HIV, HTLV, hepatitis B and C, syphilis –         Excellent health without any chronic illnessesor history of major medical issues such as cancer, leukemia –         Non smokers and not consumed caffeinated drinksmore than 200 mlA womandonor would not be eligible if: (20)-         Uses illegal drug-         Smokes or uses alcohol-         Has received blood transfusion or blood productexcept Rhogam in the last 4 month-         Has received an organ or tissue transplant inlast 12 months-         Has more than 2 ounces of alcohol per day regularly-         Has positive blood test result for HIV, HTLV,hepatitis B or C or syphilis-         She or her partner is at risk for HIV The KKWomen’s and Children’s Hospital (KKH) in Singapore also follows the strictguidelines and protocol set by the United Kingdom National Institute of Healthand Care and Human Milk Banking Association of North America for screeningdonors, processing and dispensing the donated human milk.(22) The Human MilkBanking Association of North America is a non-profit association, in Singapore,the milk donation is also a voluntary initiative and the donors will not bepaid. This is done to ensure that milk is not tampered with for monetary gainsand to ensure that mothers do not deprive their own infants of their milk formonetary gain.

(23) BENEFIT OFHUMAN MILK BANKTO MOTHERSThere aresome mother conditions that not favour breastfeeding. Breastfeeding iscontraindicated in:1.       Mothers whohave positive Human T-cell Lymphocyte Virus-1 (HTLV-1). According to researchdone in Miyazaki Medical College in Japan, in 30 bottle-fed babies wereexamined 24 months after birth and there was only one was found to be HTLV-1positive compared to breast-fed babies, there was 24 babies out of 30 babieswho were born to positive HTLV-1 mothers got detected with HTLV-1 in their 24thmonth.

(24) Vertical transmission of HTLV-1 could occur during intrauterineperiod or during delivery. However, it is has been shown that major of itstransmission is via breastfeeding, the HTLV-infected cells enter the infantsbody by the oral route. An exposure period of higher than 6 months and highproviral load in breast milk usually considered risk factors of HTLV infectiontransmission. (25) In view of those studies, we could see that infant withmother who positive HTLV barely get breastfeeding by their mothers, wherebreast milk is valuable for nourishing as well as in immunity to protectagainst various infectious agents. Therefore, human milk bank may be abeneficial to these infants to get good nutrients and immunologic componentsbesides only having formula milk.2.       Human immunodeficiencyvirus (HIV) positive mother.