Call to action for equitable access to human milk for vulnerable infants.
Call to action for equitable access to human milk for vulnerable infants.
复制标题
DOI：
10.1016/s2214-109x(19)30402-4
复制
发表时间：
2019-11
期刊：
影响因子：
--
通讯作者：
Oxford-PATH Human Milk Working Group
中科院分区：
文献类型：
--
作者：
Israel-Ballard K;Cohen J;Mansen K;Parker M;Engmann C;Kelley M;Oxford-PATH Human Milk Working Group
母乳喂养是人类生殖的一个组成部分，由于母乳具有独特的营养和免疫活性特性，可防止因采用替代喂养方法而导致的婴儿死亡。1联合国儿童基金会和世卫组织强调母乳喂养在实现可持续发展目标（SDG）方面的关键作用，包括改善儿童营养（SDG 2）、预防儿童死亡和降低非传染性疾病风险（SDG 3）以及支持认知发展和优质教育（SDG 4）。虽然有大量证据支持母乳喂养对婴儿健康和发育的重要性，但由于产妇死亡、疾病或分离，世界各地的许多婴儿无法获得母乳喂养或自己的母乳。全球新生儿重症监护病房中多达40%的婴儿在出生后的最初几天或几周内无法获得足够的母乳。2这些脆弱的婴儿-主要是低出生体重的早产儿-与足月或健康婴儿相比，由于严重的消化系统并发症、感染和生长或发育延迟而发生发病和死亡的风险更大。对于这些婴儿，世卫组织建议通过母乳库安全使用捐赠母乳，作为降低风险的关键策略。为了满足这一需求，60多个国家建立了600多个母乳库，但大多数位于欧洲、美国、亚洲和巴西，仅巴西就有230多个母乳库的国有化系统。4、需要更多的银行。母乳库通过招募母乳捐献者，以及收集、加工、筛选、储存和分发安全的母乳捐献者发挥关键作用。如果不确保建立一个强大的全球母乳喂养文化和支持系统，并非所有脆弱的婴儿都能获得捐赠的母乳。由于缺乏指导捐助方案的全球政策和标准，母乳库的全球规模扩大受到阻碍。例如，对于将母乳分类为食品、组织、药物或其他可能的监管分类，没有达成共识，这对母乳库的管理和立法具有重要意义。迄今为止，在大多数国家，母乳库正在制定操作系统和指导方针，但没有进行系统的协调，或对全球最佳做法的指导有限。政策制定者、监管者、卫生工作者和母亲在促进和引导支持性母乳喂养环境时必须考虑一些重要的伦理因素，包括在不同的社会经济背景下提供母乳。
Breastfeeding, which is an integral component of human reproduction, prevents the infant mortality associated with alternative feeding methods owing to the unique nutritional and immunoactive properties of human milk. 1 UNICEF and WHO emphasise the crucial role of breastfeeding in addressing the Sustainable Development Goals (SDGs), including improving child nutrition (SDG 2), preventing child mortality and decreasing the risk of non-communicable diseases (SDG 3), and supporting cognitive development and quality education (SDG 4). Although extensive evidence supports the importance of breastfeeding for infant health and development, many infants worldwide do not have access to breastfeeding or their own mother’s milk because of maternal death, illness, or separation. Up to 40% of infants in neonatal intensive care units globally cannot access sufficient mother’s milk during during the first days or weeks of life. 2 These vulnerable infants—mainly preterm neonates with low birthweight—are at greater risk of morbidity and mortality from severe digestive complications, infections, and delayed growth or development than full-term or healthy infants. For these infants, WHO recommends safe use of donor human milk through human milk banks as a key risk reduction strategy. 3 To address this need, over 600 human milk banks have been established in more than 60 countries, but most are in Europe, the USA, Asia, and Brazil, with a nationalised system of more than 230 human milk banks in Brazil alone. 4 More of these banks are needed. Human milk banks serve a critical role by recruiting milk donors, and collecting, processing, screening, storing, and distributing safe donor human milk. Without ensuring a strong global breastfeeding culture and support system, not all vulnerable infants will have access to donor human milk. Global scale-up of human milk banks has been hampered by the absence of global policies and standards to guide donor programmes. For example, there is no consensus on the classification of human milk as a food, tissue, medicine, or other possible classification for regulatory purposes, which has important implications for how human milk banks are governed and legislated. To date, in most countries, human milk banks are developing operating systems and guidelines without systematic coordination or with limited guidance on global best practices. There are a number of important ethical considerations that policymakers, regulators, health workers, and mothers must consider in facilitating and navigating supportive breastfeeding environments, including the provision of human milk within different socioeconomic contexts.