to World Health Organization (WHO), breastfeeding is the normal way to provide
young infants with the nutrients they need for healthy growth and development.
Breast milk is recommended by WHO as the perfect food for the newborn and
feeding should start within the first hour after birth. Exclusive breastfeeding
is recommended up to 6 months of age and continued along with appropriate
complementary 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 as
Allah has stated in Quran in surah Al Baqarah verses 233 which recommends a 2
year period of lactation: (2,3)

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And the mothers (married or divorced) should suckle their
(born) children for two whole years, (that is) for those who desire to complete
the term of suckling, and their nutrition and clothing must be upon the father
according to custom and usage (on a reasonable basis, bi’l ma’rûf); no soul
shall have a burden laid on him greater than he can bear. A mother should not
be made to suffer harm because of her child, nor should the one for him the
child was borne (the father) because of his child. And a similar devolves on
the heir. But if both desire weaning by mutual consent and counsel, there is no
sin on them, and if you wish to engage a wet-nurse for your children, there is
no sin on you so long as you pay what you promised for according to custom and
usage (on a reasonable basis); and have piety (takwâ) towards Allah and know
that Allah is All-Seeing of what you do.


About one
in eight babies are born preterm. Preterm infants have higher risk of
necrotising enterocolitis if not being breastfeed.(4) They also have premature
immune and digestive systems, therefore exposure to the cow’s milk can expose
them to feeding intolerance and potential development of necrotising
enterocolitis (NEC).(5) Necrotising enterocolitis is a condition that can cause
damage to the intestine that caused by tissue death. Therefore, this human milk
bank may become a help to the infants to grow and get benefit from the breast

infants have altered host defences which increase their susceptibility to
necrotising enterocolitis. They have reduced gastric proteolytic enzymes,
increased gastric ph, reduced intestinal motility, increased intestinal
permeability, altered epithelial membrane tight junctions and diminished intestinal
mucus coat.(6) Clinical studies with Mothers own Milk shown that there is
reduction in 50% in the rate of getting necrotising enterocolitis and a
shortened length of hospital stay compared to mothers own milk and formula or
formula alone.(6)



Stages of
lactation start with colostrum which present in the first three days after
birth, has a yellow color with thick consistency. Colostrum has higher amount
in protein and low in fat and sugar. The protein is three times higher than
mature milk, because it is rich in antibodies that being passed from the
mother. These antibodies protect the babies and act as laxatives which help the
babies pass the first stool called meconium.(7, 8) Colostrum also rich in
immunologic components such as secretory IgA, lactoferrin, leukocytes as well
as epidermal growth factor. (9)

The milk
will 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 and
315 kJ per 100 ml. mature milk continues to provide immune factors and other
non-nutritional components to the infant. (7, 8)

maternal diet is not always optimal, thus, continuing multi-vitamins during
lactation is recommended. Regardless of maternal diet, Vitamin K is extremely
low in human milk and thus, the American Academy of Pediatrics recommends an
injection of this vitamin to avoid hemorrhagic disease of the newborn. Vitamin
D also occurs in low quantity in human milk, particularly with low maternal
exposure to sunshine, a circumstance now common in populations worldwide. While
the impact of maternal supplementation with vitamin D on milk composition is
under investigation, current pediatric recommendations target postnatal vitamin
D supplementation of breastfed infants. (9)



Human milk
bank or Mothers’ milk bank is a service which collect, test, processes and
provides donor human milk to the babies. Babies who receive donor human milk
may 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 Temasek
Foundation Cares to launch the Breast Milk Bank on 17 August 2017. They have put
requirement for donated milk, which are pre-term infants have to be born at
less than 32 weeks of gestation, weighing 1.8kg or less at birth and at high
risk of getting necrotising enterocolitis or has been diagnosed with
necrotising enterocolitis.(12)

Human milk
bank also may offers solution to the mothers who cannot supply their own breast
milk to their child, for example, the mothers who have been diagnosed with a
particular health condition that can be passed to the breastfed infant such as
infected with human immunodeficiency virus (HIV).(11) In preparing and
processing donated human milk, Human Milk Bank Association of North America
(HMBANA) has established guidelines and policies for donor human milk
collection.(13) Donor human milk must be pasteurized, stored and mixed.
Singapore also adheres to strict guidelines and policies of HMBANA for
screening donors, processing and dispensing the donated human milk.(14)


process of donor human milk


**from KKH


milk should be refrigerated immediately at 4 °C in refrigerator for up to 24 hours. Raw donor milk can be stored
frozen at -20°C for up to three months. It should not be stored frozen for more
than 3 months because of lipolytic activity and loss of vitamin.(15) Once donor
milk is selected for processing, the frozen milk is thawed and pooled under a
sterile condition. Each pool is thoroughly mixed to ensure an even distribution
of 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 2
hours before pasteurisation.(13, 14, 16) Holder pasteurisation method is the
primary method used by HMBANA milk banks. This method is done by heating the
milk at 62.5°C for 30 minutes.(13) Pasteurisation kills the viruses and
bacteria that may be harmful to fragile infants while retaining majority of the
milk beneficial components.(17) Bacterial culture is taken before and after the
pasteurization and any milk that is culture positive for any pathogen or for
greater that 104 colony-forming units/mL of skin flora is
discarded.(18) According to HMBANA guidelines, the pasteurised donor human milk
is frozen and stored. It can be dispensed to the recipient after the samples
are culture and show no culture/bacterial growth.(16)



There are
meticulous screening and tests that a donor must undergo to donate their
milk.(18) These screening and tests must be considered as we want to make sure
that the milk are safe to be given to the infants. According to Human Milk Bank
Association of North America, all donors undergo screening process that begins
with telephone interview. Donor must be: (19, 20, 21)

Confident in her milk supply and produce milk
in excess of her own baby’s needs

In a good health

Not regularly on medication or herbal

Willing to undergo blood test to be screened
for HIV, HTLV, hepatitis B and C, syphilis

Excellent health without any chronic illnesses
or history of major medical issues such as cancer, leukemia

Non smokers and not consumed caffeinated drinks
more than 200 ml

A woman
donor would not be eligible if: (20)

Uses illegal drug

Smokes or uses alcohol

Has received blood transfusion or blood product
except Rhogam in the last 4 month

Has received an organ or tissue transplant in
last 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 KK
Women’s and Children’s Hospital (KKH) in Singapore also follows the strict
guidelines and protocol set by the United Kingdom National Institute of Health
and Care and Human Milk Banking Association of North America for screening
donors, processing and dispensing the donated human milk.(22) The Human Milk
Banking Association of North America is a non-profit association, in Singapore,
the milk donation is also a voluntary initiative and the donors will not be
paid. This is done to ensure that milk is not tampered with for monetary gains
and to ensure that mothers do not deprive their own infants of their milk for
monetary gain.(23)




There are
some mother conditions that not favour breastfeeding. Breastfeeding is
contraindicated in:

1.       Mothers who
have positive Human T-cell Lymphocyte Virus-1 (HTLV-1). According to research
done in Miyazaki Medical College in Japan, in 30 bottle-fed babies were
examined 24 months after birth and there was only one was found to be HTLV-1
positive compared to breast-fed babies, there was 24 babies out of 30 babies
who were born to positive HTLV-1 mothers got detected with HTLV-1 in their 24th
month.(24) Vertical transmission of HTLV-1 could occur during intrauterine
period or during delivery. However, it is has been shown that major of its
transmission is via breastfeeding, the HTLV-infected cells enter the infants
body by the oral route. An exposure period of higher than 6 months and high
proviral load in breast milk usually considered risk factors of HTLV infection
transmission. (25) In view of those studies, we could see that infant with
mother who positive HTLV barely get breastfeeding by their mothers, where
breast milk is valuable for nourishing as well as in immunity to protect
against various infectious agents. Therefore, human milk bank may be a
beneficial to these infants to get good nutrients and immunologic components
besides only having formula milk.

2.       Human immunodeficiency
virus (HIV) positive mother.