After promises by successive Israeli health ministers over more than 15 years and the preventable deaths of “several hundred” premature babies over this period due to the lack of it, a National Human Milk Bank has been established in Israel. Magen David Adom (MDA) – the country’s National Emergency Pre-Hospital Medical and Blood Services Organization – has come to the rescue, opening the facility at its main Jerusalem station, with funding from the National Insurance Institute (NII).
”My contention is that the care of the newborn always falls between the proverbial cracks; in essence, the newborn/infant is an administrative orphan as the financial responsibility or its care is neither in the Health Ministry or the four public health maintenance organizations (HMOs), but rather the NII, which is not a medical entity,” renowned Jerusalem neonatologist and pediatrician Prof. Arthur Eidelman, who has been pushing for a mother’s milk bank for years, told Israel365 in an interview. “As a result, there is no one in the ministry or the health insurers who sees this as their direct responsibility and thus does push it. You can add to this that issues related to nutrition – let alone women’s issues such as breastfeeding – have always had poorer status and emphasis in the health system. Paradoxically, it’s not ‘sexy’ or ‘hi-tech’ enough to catch someone’s fancy or priority. It’s too mundane for most and not a personal issue to those who set policy.”
Eidelman, who headed the pediatrics and neonatal departments at Jerusalem’s Shaare Zedek Medical Center, a professor at the Hebrew University Medical Faculty for many years and, since his retirement, has been serving as editor-in-chief of the prestigious Breastfeeding Medicine journal, added: “It is inherent in the system. If the ministry and the HMOs don’t pay for the care of the newborn, there is nobody in the end who will take the lead in adding and financing any new care –despite the pleading and pressures from the neonatology physicians and nurses and individual families whose babies are at risk.”
Re-reading articles I have written on the subject since 2005 is depressing. In 2005, then-health minister Dan Naveh declared in honor of Breastfeeding Encouragement Week that his ministry would help establish a mother’s milk bank to feed the then-700 premature babies born under 1.5 kilos with a risk for developing gastrointestinal disease that deteriorate with commercial milk formula and whose mothers could not breastfeed. But nothing came it. In 2006, pediatrician and ministry official Prof. Yona Amitai introduced the idea of setting up a mother’s milk bank. In that year, the Knesset even passed a law in 2006 “establishing a national mother’s milk bank,” but it was never implemented.
In 2014, when Naveh was long gone, the Health Ministry issued guidelines for the establishment of a mother’s milk bank that would scrutinize would-be milk donors, would freeze, pasteurize then re-freeze milk and be responsible for the logistics of bringing the milk to the country’s general hospitals. Until the discovery of the HIV virus in the early 1980s, a few groups of ultra-Orthodox Jewish women who had recently given birth have privately donated milk they pumped for premature infants of other women who could not breastfeed and whose premature infants suffered from the serious gastrointestinal disorder necrotizing enterocolitis (NEC), which occurs in up to 5% to 8% of neonatal intensive care unit patients. Symptoms of NEC include poor feeding, bloating, decreased activity, blood in the stool, vomiting of bile, bowel death, multiorgan failure and even death. About 7% of those that are born premature develop necrotizing enterocolitis. Onset is typically in the first four weeks of life, and among those affected, up to 25% die.
Tiny infants, whose immature bowels are sensitive to changes in blood flow and prone to infection, may develop NEC; in severe cases, a hole can develop in the intestine, allowing bacteria to leak into the abdomen and cause life-threatening infection. But in the absence of an official mother’s milk bank, some mothers of premature babies even purchased frozen breast milk via the Internet. The haredi women’s milk was consumed without checking the donors for deadly infectious diseases including HIV, hepatitis B; without rejecting women who smoked, drank a lot of coffee, took dangerous drugs and medications or had a poor diet; and without any involvement from the Health Ministry. Ensuring that the milk was donated and stored in a sanitary way was also vital.
In 2017, two Knesset members presented a private members’ bill to require the Health Ministry to establish a regulated and supervised breast-milk bank. The ministry said it had decided to set up such a bank and even allocated NIS 1 million for its establishment. In September of that year, the ministry said it planned to open a mother’s milk bank by mid-2018. Health Ministry spokesman and deputy director-general for information, Einav Shimron-Greenbaum declared then that “the ministry has been talking about this for some time, and it intends to fund the establishment of such a national milk bank soon. We have already issued 17 pages of detailed guidelines, as the matter is very complicated. The guidelines deal with many matters, including setting criteria regarding which infants need it; who can work there; physical requirements for the bank; how to handle the milk from pumping until it is given to the infant (including handwashing by the donor and pasteurizing, freezing and defrosting of the milk); signing forms for donations; checking the health and lifestyle of the donor and what medications she takes; saving samples for testing and management of milk supplies.”
Shimron-Greenbaum is still a senior official in the ministry, but she did not respond to Israel365’s request this week to interview officials, including pediatrician Dr. Deena Zimmerman, head of the ministry’s maternal, child and adolescent health department, even though she was eager to speak about the subject. All the ministry spokesman, Eyal Basson, was willing to say was that “a few weeks ago, financial disputes arose with MDA over the bank that partially suspended its activities. However, things were settled and the milk supply returned to normal operation. Never was the milk supply to preterm infants halted. Setting up a such a facility takes time. Since the writing of the standard for operation in 2016, there has been steady progress in building the bank as a joint venture between MDA and the ministry.”
Despite ministry bureaucracy, procrastination and apathy, the Human Milk Bank is a fact, largely due to the efforts of Dr. Sharron Bransburg-Zabary, who has been working on the project since 2018, serving as a co-founder of the Mother Milk Donation Organization of Israel and now serves as its director. “I started from zero. Such a project is very complicated, much more so than a blood bank,” she told Israel365. “It must meet strict standards. The ministry didn’t want to pay for it or be responsible for it. Even the hospitals, which all have in-vitro fertilization units where premature babies are often born, showed little interest in pushing for a mother’s milk bank.”
Bransburg-Zabary, who has a doctorate in biophysics and computational biology and is certified lactation consultant, works for MDA. She said that the bank has some 120 registered women milk donors, with about 30 giving at any one time. “There was no ministry publicity about the project, but we found the donors through mother-and-baby clinics and Facebook. We hope to have three or four full-time workers and will move to MDA’s Central Blood Bank near Tel Aviv next year.” Some ultra-Orthodox women are among the donors, but as they usually have very large families and live in small apartments, sterile conditions are difficult to maintain. They also don’t like to give blood samples that are necessary before they are approved.” At present, regulations allow for supplying the milk only to premature baby units and not to mothers of older babies who need mother’s milk rather than formula.
One of the hospitals that have already received mother’s milk from the new bank to feed premature babies in its neonatal intensive care unit is Carmel Medical Center in Haifa. Lactation coordinator Tali Zim said in an interview: “The first recipient in Israel was a premature baby boy with NEC who was unable to digest special formula and whose mother couldn’t pump, followed by a second baby who couldn’t nurse for medical reasons. Now he is thriving. Mother’s milk for premature babies is lifesaving.”
Donated breast milk can prevent and treat NEC and also serve as a bridge until the mother can nurse by herself, said Zim. “The investment in running a milk bank is so small, but outcome is so great. It reduces sickness and deaths. Taking care of defective children for years or the rest of their lives is much more expensive, not to mention the children’s and the families’ suffering.”
Dr. Shmuel Tzangan, chief of neonatology and pediatrics at Barzilai Medical Center in Ashkelon and chairman of the Israel Neonatology Society, has been advocating the establishment of a mother’s milk bank similar to those in many countries – from the US to Europe to South America (Brazil has one of the best). “Finally, a few weeks ago, an agreement was signed between the Health Ministry and MDA to supply annually 4,000 liters (between 200 and 300 liters a month) to the 26 hospital premature baby units at 90 agorot [about 30 US cents) per cubic centimeter. The NII pays hospitals large sums for delivering and treating premature babies, and the payment for the milk will be added. The facility could have been set up many years ago, but it wasn’t a top priority of the Health Ministry.”