Screening donated breast milk in the developing world: Market evaluation and needs identification for rapid and sustainable methods of screening donated milk at human milk banks

Human breast milk is considered the gold standard for infant nutrition, as breast milk is the only substance that is able to provide infants with the necessary nutrients in their first six months of life. Infants who are fed mother's breast milk are at lower risk for developing a variety of infections and autoimmune diseases and often display better developmental and cognitive performance compared to infants who are not fed breast milk. Most notably, studies have shown that breastfeeding could prevent up to 13% of child deaths worldwide [5]. However, many women are unable to breastfeed for a variety of reasons, including immuno-compromised status due to diseases such as HIV/AIDS, lack of time, or cultural pressures to use infant formula. In an attempt to solve this problem, there has been a global emergence of human breast milk banks that receive breast milk from screened donors and pasteurize the donated breast milk for distribution. However, the process of ensuring that donor milk is safe for use through pasteurization and screening via bacterial culturing is costly and time-consuming. Accordingly, a standardized implementation of the process has ranged widely. Furthermore, there are a lack of universal guidelines regarding the processing and treatment of breast milk donations around the world. This paper presents a comprehensive review detailing the different methods of pasteurization (including the Holder Method and flash pasteurization) and screening (such as Dornic acidity, bacterial culturing, and crematocrit method) at human milk banks in both developed and developing countries. Understanding different practices worldwide will help in identifying gaps in current efforts to ensure the safety of donated milk, highlighting areas for possible technology development and implementation. Our review demonstrates that few, if any solutions, currently exist for screening donated milk in a cost-effective and efficient manner.