Guiding the implementation of a future National Milk Bank Service

我的UKRI FLF扩展阶段的目的是了解英国母乳银行服务的实施情况。在我的FLF开始之前，英国的母乳银行服务通常是资源不足的小型服务，新生儿学家之间就是否有必要进行辩论。从那时起，在我的FLF期间发表的工作以及全球其他人的工作强调了获得捐赠人乳可以在个人层面（在支持产妇心理健康和改善补充喂养的不良婴儿结果方面）以及在支持母乳喂养和更广泛地认识人乳方面在社会层面（在支持母乳喂养方面）产生广泛的公共卫生影响。今年，世卫组织成立了一个指南制定小组，旨在为全球母乳库的运作建立最低标准，并且临床意识日益增强，即应该为无法获得母乳的婴儿（包括足月婴儿和早产儿）提供捐赠的母乳作为补充。由于2022年的配方奶粉短缺，脆弱的婴儿没有安全的喂养选择，人们也更加关注这一行业。为了满足医院服务的需要，美国的母乳库必须将产量增加四倍。英国目前没有针对这种情况的应急计划，但在不久的将来很可能出现类似的供应短缺。我的FLF的主要目的是创造证据，为国家母乳银行服务的建立提供信息，让人们有公平的机会捐赠和接受捐赠的母乳。对这种服务的需求在很大程度上已经确定，但是存在许多不适当的服务实现的风险。这些问题包括安全风险、缺乏公平性、商业化、服务提供中断以及未能尽可能支持母乳喂养。因此，我的短期研究基金的第二阶段将建立在我的UKRI短期研究基金第一阶段奠定的基础上，补充迄今取得的工作，并建立一个广泛实施研究的连贯方案。拟议的计划将建立在我的UKRI FLF第一阶段汇集的不同利益相关者和学术专业知识网络的基础上，以在英国进一步扩大牛奶银行服务之前解决这些差距，跨越四个工作流程：1)研究小组将使用Sekhon等人最近建立的关于复杂公共卫生干预措施的范例，使用各种方法，包括调查、半结构化访谈和与关键利益相关者的研讨会，以及焦点小组，对供体牛奶的可接受性进行评估；2)与卫生经济学家Hema Mistry博士合作，对成本效益和成本核算进行强有力的评估，以促进未来的服务规划；3)整合一个新的捐赠门户网站，促进母乳捐赠者的招募、沟通和支持，这是我在奖学金的第一阶段开发的，将被整合到Li-Lac母乳银行跟踪系统中，并根据2020-2022年的审计数据评估改善捐赠体验和捐赠数量的有效性；4)在将应急计划人员与牛奶库和儿科专家聚集在一起的初步研讨会的基础上，将继续共同设计应急响应和服务连续性计划，在整个英国牛奶库中加强风险管理，并将冻干牛奶作为在该部门建立复原力的一种方法。这项工作将对提高母乳喂养率的棘手领域产生广泛的影响，无论是在英国还是在全球。在最近举行的世卫组织欧洲区域母乳库网络研讨会上，主席总结说，“母乳库的案例已经提出，现在的重点应放在实施上。”我的团队在应对这一挑战方面处于独特的地位。

The purpose of the extension phase of my UKRI FLF is to understand the implementation of human milk bank services in the UK. Prior to the start of my FLF, milk bank services in the UK were generally small under-resourced services, with debate amongst neonatologists about whether they were necessary at all. Since then, the work published during my FLF and from others globally have highlighted the breadth of public health impacts that access to donor human milk can have on both the individual level, in terms of support for maternal mental health and ameliorating adverse infant outcomes of supplemental feeding, and at the societal level with regards to support for breastfeeding and broader perceptions of human milk. This year, the WHO has launched a Guideline Development Group aiming to establish minimum standards globally for the operation of human milk banks, and there is an increasing clinical awareness that donor milk should be available as a supplement for infants where maternal milk is unavailable, including term as well as preterm infants. Greater focus on the sector has also arisen as a consequence of the 2022 formula shortages where vulnerable infants were left without safe feeding options. Human milk banks in the USA had to quadruple output to meet the needs of hospital services. There is currently no emergency planning for such circumstances in the UK context, but a high likelihood of similar supply shortages developing in the near future.The main aim of my FLF was to create evidence that could inform the creation of a National Milk Bank Service, with equitable opportunity to donate and receive donor milk. The need for such a service has largely been established, but there are a number of risks of inappropriate service implementation. These include safety risks, lack of equity, commercialisation, disruption to service provision, and failure to support maternal breastfeeding where possible. Phase 2 of my FLF will therefore build on the foundations laid in the first phase of my UKRI FLF, complementing the work achieved so far, and establishing a cohesive programme of broad implementation research. The proposed programme will build on the network of diverse stakeholders and academic expertise brought together within the first phase of my UKRI FLF to address these gaps before milk banking services are further scaled in the UK, working across four workstreams: 1) the research team will make an assessment of donor milk acceptability using paradigms established recently on complex public health interventions by Sekhon et al., using a variety of methods that include surveys, semi-structured interviews and workshops with key stakeholders, and focus groups; 2) working with health economist, Dr Hema Mistry, a robust assessment of cost-effectiveness and costings will be conduct to facilitate future service planning; 3) the integration of a novel donor portal, facilitating the recruitment, communication and support of milk donors, developed during the first phase of my fellowship will be integrated into the Li-Lac milk bank tracking system and evaluated for efficacy in improving donor experience and volume donated against audited data from 2020-2022; 4) building on preliminary workshops that bring together emergency planners with milk banking and paediatrics experts, work will continue to co-design emergency response and service continuity plans, entrench risk management throughout UK milk banking, and establish the utility of freeze-dried milk as a method of building resilience in the sector. This work will have broad ranging impacts on the intractable area of increasing breastfeeding rates, both in the UK and globally. After a recent presentation WHO European Region webinar on human milk banking, the Chair concluded that, "the case for milk banking had been made - now the focus should be on implementation." My team are in a unique position to meet this challenge.