PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON THE KNOWLEDGE REGARDING HUMAN MILK BANKING AMONG STAFF NURSES IN SELECTED HOSPITAL , TUMKUR.”

SUBMITTED BY

Miss. SUBHA XAVIER,

IST YEAR M.Sc. NURSING, OBSTETRICS AND GYNAECOLOGICAL NURSING,

SRI RAMANAMAHARSHI COLLEGE OF NURSING,

TUMKUR,

2010 - 2011.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION.

1. / NAME OF THE CANDIDATE AND ADDRESS / MISS.SUBHA XAVIER,
1ST YEAR M.Sc. NURSING,
SRI RAMANAMAHARSI COLLEGE OF NURSING,
TUMKUR,
2. / NAME OF THE INSTITUTION / SRI RAMANAMAHARSI COLLEGE OF NURSING
3. / COURSE STUDY AND SUBJECT / 1ST YEAR M.Sc. NURSING,
OBSTETRICS AND GYNAECOLOGICAL NURSING.
4. / DATE OF ADMISSION TO COURSE / 01-06-2010
5. / TITLE OF THE STUDY / “THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON THE KNOWLEDGE REGARDING HUMAN MILK BANKING AMONG STAFF NURSES IN SELECTED HOSPITAL”, TUMKUR.

6.BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION

“Mother’s milk, time-tested for millions of years, is the best nutrient for babies because it is nature’s perfect food”

Robert S Mendelsohn

Health is wealth for the good health we need good nutrition.Nutrition for babies get from mother’s milk. Breast Milk is the safest and best protective food for infants and also the best choice to feed premature and ill babies. Superiority of human milk is due to its superior nutritive and protective value. It provides total nutrient requirement for the first six months of life. It also prevents malnutrition and allow the child to develop fully. But when there is not enough mother’s milk available due to some reasons like mother has insufficient milk glands, has had past breast surgery or is taking medication(eg: chemotherapy for cancer) and has an infection that could spread to her baby through breast feeding. For these babies an alternative must be sought1 .

In the past , the practice of Wet nursing provided an alternative to maternal breast feeding for those who could access it. When a wet nurse was not available, milk from goats sheep and other mammals were also used as substitute nourishment for babies, often with fatal results.but in late 1950’s concept of human milk banking started.In 1980’s at the World Health Assembly, the WHO and UNICEF jointly declared “ where it is not possible for the biological mother to breast feed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in appropriate situations2

A Human Milk Bank is a service which collects, screens, processes and dispenses by prescription of human milk donated by nursing mothers who are not biologically related to the recipient infant.The milk extracted at banks may be of three kinds. The colustrum extracted in the first four days from a woman is given to babies infected with diarrhoea and malnutrition or those suffering from burn injuries. The milk collected over next 5-10 days is “transitional milk” and the milk collected thereafter is called “mature milk” which has less protein. The quantity drawn with the help of a pump, ranges from 40-600cc per mother. After extraction, the milk is cooled and poured into autoclave stainless steel containers measuring 150cc, 250cc or 300cc. It is then pasteurized at 65oC for 30minutes and then frozen at -20oC. This can be stored for up to 6 months. Random culture is conducted in which microbiological testing is done for HIV and Syphilis3.

Appropriate safety standards and procedures should be used by all milk banks. Screening of donors of breast milk must include history taking for acute or chronic infectious and drug use. Expressed Breast Milk should be stored at 3oC -4oC if it is to be used within 48 hrs and at -20oC and lower if it is to be stored for more than 48hrs. Because of the dangers of microbiologic contamination, pooled milk should be pasteurized before use. Although the standards are empiric, it has been suggested the breast milk that is free of pathogens and has a total bacterial colony count of less than 10(7)/L at the time of sampling is safe to use. A fear of transmission of viruses such as HIV in body fluids led to anxiety about donation of breast milk and inhibited the momentum of the milk bank movement. Despite such hurdles, there’s no denying that human milk banks have a vital function to perform in the society4.

All efforts are made to convince lactating mothers to dispel doubts and misgivings about the process. The nurses always manage to convince mothers to donate milk during their stay at hospital. In addition, mothers of infants who die sometimes choose to donate their milk. Paediatricians in NICU will have the opportunity to educate parents regarding the benefits of breast milk over commercially available formula. Current information will allay fears of viral and bacterial transmission. It is encouraging to see that milk banks have been running successfully now in many countries. Communities with milk banks use different methods to educate and solicit donors including brochures and information packets. Referrals also come from childbirth educators and nursing mothers’ groups.5

(6.1) NEED FOR THE STUDY

“O, thou beautiful damsel, may the four oceans

Of the Earth contribute the secretion of milk

In thy breasts for the purpose for improving

The bodily strength of the child

O, thou with the beautiful face, may the child

Reared on your milk, attain a long life, like

The Gods made immortal with drinks of nectar”

Sushrutha

Human Milk is an essential food for newborn and affects life in the long or short terms. Its composition is modified by nutritional status and maternal diet as well as by gestational age of the newborn. It provides human milk fed infants with the medium chain fatty acids which are a source of energy and essential fatty acids and their metabolic derivatives which have been involved in the neural matuaration7.

Human Milk banks exist to provide human milk to the needy babies for medical reasons where the natural mother is unable to breast feed. Milk banks accept, store and redistribute donated human milk. Because babies who use donor milk are not related to the donors, every possible step is taken to ensure the is safe. All screening and testing of donor mother and donor human milk is carried out by the milk banks that have guidelines which are reviewed regularly in the light of current scientific and practical knowledge. The milk banks also play an important role in sharing information among experts on human milk, providing information to medical community and encouraging research on the unique properties of human milk8

.

Medical indications for supplementing the intake of a breastfed newborn infant at term include clinical hypoglycaemia, dehydration and infection. Banked milk is also used for older babies and children in conditions such as formula intolerance, gastroenteritis, malabsorption and post operative nutrition. Milk banks help mothers provide breast milk for premature babies. Recent work has demonstrated improved clinical outcomes in preterm infants fed human milk as opposed to formula, in particular, the incidence of infection and necrotizing enter colitis {NEC} is significantly lower in babies fed human milk, whether or not it has been pasteurized and neurodevelopment outcome for premature infants is seemingly improved.6

Milk banks not only saves lives but also money. Of those babies who acquire NEC up to 62% die from it, while 1.5% of premature infants fed mother’s milk acquire NEC, 10-17% of premature infants fed formula acquire NEC.While the majority of breast milk is used to benefit babies and young children. Donor human milk is presently being used to lessen infection among adults who have undergone liver transplants with very good results. Other important medical uses for this magical substance are being investigated. Breast Milk can also protect against otitis media, pneumonia, diarrhoea, NEC and sepsis. The primary protective factors in breast milk are the presence of specific antibody and anti-adhesion factors in human milk. However, a variety of antimicrobial factors have been detected in human milk over the years. Most of these factors are not destroyed by pasteurization.[62.5oC for 30 minutes]6

The demand for banked human milk has been increasing, in large part due to the benefits associated with its use. Multiple levels of safe guarding built into current milk banking process have resulted in an unblemished safety record for banked milk in North America. Holder pasteurization destroys many pathogens in human milk while preserving much of the biologically active content. Among the potential benefits of using banked human milk in the NICU are promotion of breast feeding, reducing the incidence of sepsis and possible support of long term positive neuro developmental outcomes in very low and extremely low birth weight babies.Premature or sick babies and children, whose mothers are not able to produce their own milk, many times due to illness, medication, adoption or foster care need your breast milk. Mothers who are healthy and breast feeding may be able to donate to a milk bank10.

Over the past 100 years, North America milk banking has evolved from an idea to a sophisticated process. The early history of establishment of North American banks, including screening processes undertaken, provides the basis for current procedures in modern banks. Increased research and technological improvements have also dramatically changed modern screening procedure. Human milk banks have and assertive marketing of infant formula. With increasing awareness of the modern milk banks, demands is increasing, leading to greater interest in establishing additional banks.9

According to Dr.Armida Fernandez, founder of India’s first human milk bank at Lokmanya Tilak human milk bank are crucial for India because even through the practice of women donating milk in humanitarian ground is common. It is erratic and the shelf life of such milk is not more than 24 hrs. What is required in such circumstances is a reliable institution like a milk bank which can pool, preserve and provide milk for nearly six months.7

A study conducted in 2004 by Tully M R and Lockhart-Burman L Up groove states that donor milk has been used to successfully treat a number of medical conditions in infants. This study highlights 3 such success stories describing the use of human milk bank, in cases of velocardiofacial syndrome, VLBW and failure to thrive. In 2002, more than 300 infants and young children and 15 adults received donor milk from 6 milk banks in US and 1 milk bank in Canada. Donor milk is often used to ensure optimal outcomes in full term or preterm infants until their own mother’s milk volume is sufficient to meet their needs. However human milk may be life saving therapy for infants and young children with usual medical condition11

A study conducted in Spain where 118 premature newborn were followed on successive basis; 59 fed with infant term formula (F) and 59 fed with the preserved milk of their own mother (LH). The patients were classified in 3 groups according to birth weight: I, < 999 g (n = 4/4); II, 1000-1499 g (n = 37/37) and III, 1500-1999 g (n = 18/18), each group F and LH having equal numbers. Growth, morbidity and clinical management were recorded. Necrotizing enter colitis (P <0.001), urinary tract infection (P < 0.01) and infectious diarrhoea (P < 0.01) were less frequent in LH infants and as a consequence these infants needed less antimicrobial therapy (P < 0.001), nevertheless the human milk contained flora bacteria. The LH infants of group II need fewer red cell transfusions (P < 0.001) and each group was similar and only the babies < 999 g had increments of approximately 15 g/kg/day. Statistics showed that the preserving of the human milk and administering it to the newborns was healthy and was not having any serious side effects of preserving but boosted the normal body mechanisms as per in the mothers` milk and it was far better than the formula used earlier to feed the new born baby. Babies found to be resistant to the infections and needed only less antimicrobial therapy.

In case, milk is provided for adopting babies or older children with severe food allergies. In 1988, 72% of the milk banks in the USA was prescribed for infants in NICU, 23%went to babies at home, and 2% was used for paediatric inpatient. According to Dr. Sandhya Khadse of Sassoon General Hospital in Pune, there is an urgent need to create more awareness about milk banks and motivate people to support such venture. Nurse spread awareness about bank by informing lactating mothers admitted to the hospital about the milk bank and also handles their queries related to milk donation. In India, global system of milk banking has seen slow progress while it was a popular concept in the West during 1960’s.Despite the vital services milk banks are providing in India; their number hasn’t seen a steep rise. Nor is the government doing much to promote set up of new milk banks in the future.9

These studies have proved that mothers do not have enough knowledge about human milk banking and they accept their health professionals to give adequate information regarding human milk banking. Therefore its necessary to teach the nurses about human milk banking. During the period, while the investigator worked as a staff nurse in NICU, she observed that staff nurses and student nurses had very little knowledge regarding human milk banking and the advanced research done in this programme. As a post graduate student, researcher feels that extensive programmes should be conducted to improve the knowledge regarding human milk banking to staff nurses, allied health personals and public.