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都是规模较小、资源不足的服务，新生儿专家之间就是否有必要进行辩论。从那时起，在我的母乳喂养框架期间和全球其他地方发表的工作突出表明，在支持产妇心理健康和减轻补充喂养的不利婴儿后果方面，在个人层面上，在支持母乳喂养和更广泛地理解母乳方面，在社会层面上，获得捐献的母乳可以产生广泛的公共健康影响。今年，世卫组织推出了一个指导方针发展小组，旨在为全球母乳银行的运营建立最低标准，临床上越来越多的人意识到，捐赠者的母乳应该作为补充，供无法获得母乳的婴儿使用，包括足月和早产儿。由于2022年配方奶粉短缺，脆弱的婴儿没有安全的喂养选择，因此也出现了对该部门的更多关注。美国的母乳银行不得不将母乳产量增加四倍，以满足医院服务的需求。在英国，目前还没有针对这种情况的应急计划，但在不久的将来很可能会出现类似的供应短缺。我的FLF的主要目的是创建证据，为创建国家母乳银行服务提供信息，并提供捐赠和接收捐赠者母乳的公平机会。对这种服务的需求在很大程度上已经确定，但不适当地实施服务存在一些风险。这些风险包括安全风险、缺乏公平性、商业化、服务提供中断，以及在可能的情况下未能支持母亲母乳喂养。因此，我的财务框架第二阶段将建立在我的UKRI财务框架第一阶段奠定的基础上，补充迄今取得的工作，并建立一个广泛执行研究的连贯方案。拟议的计划将建立在我的UKRI FLF第一阶段内聚集在一起的不同利益相关者和学术专业知识的网络上，以在英国进一步扩大母乳银行服务之前解决这些差距，跨四个工作流程工作：1)研究团队将使用Sekhon等人最近建立的关于复杂公共卫生干预的范例来评估捐赠者母乳的可接受性，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和焦点小组的研讨会；2)与卫生经济学家赫马·密斯特里博士合作，将对成本效益和成本进行稳健的评估，以促进未来的服务规划；3)整合在我奖学金第一阶段期间开发的新的捐赠者门户网站，以促进招募、沟通和支持母乳捐赠者，该门户网站将被整合到Li-Lac母乳银行跟踪系统中，并对照2020-2022年经审计的数据评估其在改善捐赠者经验和捐赠量方面的有效性；4)在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，巩固整个英国母乳银行的风险管理，并建立冷冻干奶作为该行业培养复原力的一种方法的效用。这项工作将对英国和全球母乳喂养率上升这一棘手领域产生广泛影响。在最近一次世卫组织欧洲区域母乳银行问题网络研讨会上发言后，主席总结说，“母乳银行的理由已经提出--现在的重点应该是执行”。我的团队在迎接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.