Screening of Drugs of Abuse in Human Milk Banks

Bastons-Compta A; Gómez A; Garcia-Algar O

doi:10.4172/2376-127X.1000e130

ISSN: 2376-127X

Journal of Pregnancy and Child Health

Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.

Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business

Screening of Drugs of Abuse in Human Milk Banks

Bastons-Compta A, Gómez A and Garcia-Algar O^*
Childhood and Environment Research Group, Institute Hospital del Mar Medical Research, Barcelona, Spain
*Corresponding Author :	Oscar Garcia-Algar Childhood and Environment Research Group Institute Hospital del Mar Medical Research (IMIM) Barcelona, Spain Tel: 0034639644139 E-mail: 90458@hospitaldelmar.cat
Received date: Mar 03, 2016; Accepted date: Mar 05, 2016; Published date: Mar 10, 2016
Citation: Bastons-Compta A, Gómez A, Garcia-Algar O (2016) Screening of Drugs of Abuse in Human Milk Banks. J Preg Child Health 3:e130. doi:10.4172/2376-127X.1000e130
Copyright: © 2016 Bastons-Compta A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Pregnancy and Child Health

View PDF Download PDF

Report

The advantages of breastmilk compared with formula have been widely studied and described. In addition to the bond created between mother and child, human milk offers advantages to healthy, premature and sick newborns because of immunoprotective and growth factors transmitted in order to prevent complications such as necrotizing enterocolitis and sepsis, as well as improvement of developmental quotient [1-3]. These benefits favor the reduction of morbidity, mortality and shorten the stay in neonatal units. Facing this evidence, WHO and other scientific societies recommend increasing breastfeeding use in neonatal intensive care units.

There is not always enough milk available from the own mother for feeding the newborn. In these cases the donated breast milk is the best alternative because of its benefits [4]. Feeding preterm newborns with donated human milk allows early onset of food by not having to wait for the mother to have own milk, improves gradual increasing tolerance to nutrients and reduces the risk of necrotizing enterocolitis when compared with formula. In recent decades, it has increased the opening of milk banks, with one common goal: to provide the most physiological and beneficial food to premature newborns and those critically ill who have no access to human milk from their own mothers. These banks have implemented security measures and methodologies in order to obtain safely human donated milk. They have created specialized centers where donated human milk is carefully selected, processed and stored in optimal conditions. With previous and strict quality controls, human donated milk is distributed according to medical prescription [5].

There are 3 different models of milk banks: 1) Community Bank, which selects milk donors, collects, stores and processes human milk to use it in external neonatal units that require it; 2) Hospital Bank, that works to cover the demand of their own neonatal unit, and 3) Hospital Bank with external projection, that distribute milk not only in their neonatal unit, but to other hospitals.

Donated breast milk is not considered within the organ transplant and tissue laws and is not considered a drug or a medical product. There is no international legislation in this regard and only guidelines published by various associations of milk banks are now available, but its recommendations lack uniformity.

Usually, during the selection process in donor milk banks questionnaire lifestyle is administrated and serological tests for hepatitis B, C, HIV and syphilis are determined. Human milk is subsequently pasteurized, ensuring the destruction of virus (potential pathogens). Proteins, fats and carbohydrates are measured to ensure the required nutritional support [6]. It is important that own or donated human milk is safe and is in the best conditions to be provided to the newborn. However, regarding legal and illegal toxics (drugs of abuse, tobacco, alcohol, etc.) that may be present in donated human milk, the only data collected are currently obtained in the questionnaires of lifestyle, which have the disadvantage of low sensitivity due to several factors such as lack of confidence to the health workers, fear of the consequences of admitting drug use and underestimation of self-perception of consumption, among others.

Despite the extensive literature on the risks related to drugs of abuse use, rates of consumption among women of childbearing age, pregnant and nursing, remains high. According to the national survey on drug use and health in the United States, a 10.8% of pregnant women between 15 and 44 years old consume alcohol, a 26.7% tobacco and 4.4% other illicit drugs. Whereas more than 25% of the world's population smokes, a high percentage of women are exposed to passive smoking during pregnancy and lactation [7]. For these reasons, it cannot be ruled out the possibility of potentially toxic substances for neonate in donated human milk [8].

In the absence of literature about the presence of toxic substances in human milk, the Hospital 12 October’s milk bank in Madrid (Spain) analyzed the validity of lifestyle questionnaire applied during the donor selection process. Fourteen illicit drugs were determined besides nicotine and caffeine in 400 samples from 63 human milk donors with liquid chromatography-mass spectrometry. It was concluded that lifestyle questionnaire was reliable for detecting illicit drug use in donors although there were some limitations in identifying passive exposure to tabacco [9].

Most of the drugs of abuse that mothers inhaled or ingested partially pass into breast milk and may alter their production volume and composition as well as having potential adverse effects on the baby. The mechanisms through which these substances are excreted in human milk are passive diffusion and active transport systems. The levels of exposure of newborn to the toxics depend on the plasma/milk ratio and also the toxic clearance in the newborn. Both drug elimination through the renal system (tubular secretion and glomerular filtration) and liver (cytochrome P450 CYP3A7) are diminished as these organs are immature in all neonates and even more in prematures. Clarification/filtering toxic are slower, favoring an accumulation that can lead to potentially harmful levels [3,4,10].

WHO, the American Academy of Pediatrics and other scientific societies have concluded that nicotine, cannabis, cocaine, amphetamines and heroin are contraindicated during lactation because of the side effects they cause.

Actually, none of the guides of European Milk Banking Networks, American, Latin American and Australian include, in the process of donor selection, the screening of drugs [11]. If hospitalized newborns consume human donated milk, it would be advisable that the absence of toxic substances that may affect their medical condition or further development were guaranteed by implementing a screening protocol for these substances in donated breast milk which could include: (1) Screening in urine sample and keep donor’s hair sample, and (2) study of milk prior to aliquoting in case of positive results in the screening. To do this, the application of technological tools currently available for the determination of drugs is fundamental. The unification of protocols between different human milk banks regarding the selection criteria and processing of milk is also necessary.

References