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The milk of human kindness

Breast milk from donors is proving helpful in the Brigham’s neonatal ICU, and the ‘liquid gold’ has also become a hot commodity on the Internet

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By Brenda Goodman
Globe Correspondent / February 14, 2011

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Any other day, James Hobbs might be found shouting orders to Marine reservists at Fort Devens, working hard to prepare them for the rigors and hazards of deployment.

But on a recent afternoon, Hobbs, 38, was finding that his considerable powers of persuasion were having little effect on a new addition to his unit.

His infant son, Ryder, who along with his three brothers, Cooper, Jax, and Finn, was born more than two months ahead of schedule on Dec. 22 at Brigham and Women’s Hospital in Boston, was refusing to eat.

Nestled against his dad’s tattooed bicep, Ryder was falling asleep as James brushed his lips with the rubber nipple of a doll-size bottle.

“I don’t think he’s going to take any more. He’s pretty sleepy,’’ said nurse Tina Steele, a lactation consultant in the Brigham’s neonatal intensive care unit.

Steele resumed Ryder’s feeding by slipping a small, soft tube down his nose and into his stomach, where it would continue to deliver steady amounts of milk.

When babies are born small and very early, as the Hobbs quadruplets were, one of their most pressing tasks in life is to grow.

In order to grow, they have to eat.

The preferred food for all babies is their mother’s own breast milk, which is rich in protective antibodies, enzymes, and growth factors that are thought to be critical to their health and development. But some moms, like Christine Hobbs, who had part of a breast removed in 2007 after cancer attacked her milk ducts, can’t make enough of their own.

Under those circumstances, infants in a hospital’s neonatal intensive care unit would normally get a soy- or cow’s milk-based formula.

But thanks to a recent change in the Brigham’s policy, the Hobbs quadruplets had a different option. They were fed breast milk from a donor, another mother who had extra to share.

The hospital changed its policy to make human milk, including milk from donors, the “standard of care’’ in January 2010, after reviewing new research that showed important health benefits for fragile babies, becoming one of the first hospitals in the United States to do that.

“The babies who get breast milk feed faster, go home sooner, than the ones who get commercial formula,’’ says Dr. Robert M. Insoft, a neonatologist who is medical director of the Brigham’s neonatal intensive care unit. “Remember, breast milk isn’t just nutritional, it’s medicinal, and especially to this population, it’s no different than giving a lifesaving antibiotic, in my eyes, because of what it contains.’’

Hospitals aren’t alone in trying to tap the benefits of breast milk. A network of 10 nonprofit milk banks in North America that pasteurize donated breast milk and distribute it to infants is set to more than double in size in the coming months, adding six more facilities — including the Mother’s Milk Bank of New England, in Newtonville, which says it will begin processing milk in March.

Adoptive moms are even using hormone treatments to induce lactation so they can breast-feed. And for women who can’t stomach the high price tags of these products and treatments — it costs about $100 a day to feed a full-term infant breast milk from a nonprofit bank — a booming white market in this “liquid gold’’ has emerged on the Internet, where breast milk is traded on sites such as Facebook and Freecycle.

According to Google Insights, a tool that measures search volume on the Internet, queries for the term “breast milk’’ doubled between January 2005 and January 2011.

There are no safeguards or quality controls in place when women casually swap milk through the Internet. But that hasn’t deterred Paige Eastman Dickinson, 40, a certified professional midwife in New Bedford, from collecting milk from generous mothers all over the state for her daughter Comfort, who is 7 months old. Eastman Dickinson had a problem lactation experts call low supply.

It’s unclear what causes low supply, but having the shortage of breast milk seems to go hand-in-hand with fertility issues and older maternal age. And as more women postpone having families into their 40s, doctors say they are seeing more who have problems with low supply.

Eastman Dickinson worked with her pediatrician for five weeks to try to breast-feed. She tried teas and supplements to increase her milk, but her baby was not gaining weight.

“I looked at the doctor and said ‘I am starving my baby,’ ’’ she said.

That started her on a quest to tap supplies of extra breast milk from friends, friends of friends, and Facebook friends, among others.

Comfort has gotten milk from more than 30 “milk mamas,’’ by Eastman Dickinson’s estimate, including a scientist at Woods Hole who turned over a cache of more than 800 ounces she’d kept in a freezer, which lasted the family for months.

Hospitals use breast milk from milk banks that carefully screen donors and then pasteurize and test their milk to reduce the risks to babies. But those kinds of safeguards don’t come cheap. Nonprofit banks charge $3 to $5 an ounce to cover the costs of processing and shipping, an amount that works out to $350 a week to feed a preemie or $700 a week to feed a full-term baby.

A California company, Prolacta, is selling hospitals a concentrated “protein shake’’ made from donated breast milk as a prescription-only treatment for premature babies. The company says it costs an average of $10,000 per infant to feed them the fortifier for two months.

As pricey as donor milk is, administrators are hopeful they may ultimately be saving money by preventing complications that require costly surgery and getting babies home more quickly. At minimum, it costs about $2,000 a day for a baby to stay in the neonatal ICU.

“Data is getting stronger and stronger about how much better these babies do,’’ says Dr. Kathleen Marinelli, a neonatologist who is director of lactation support services at Connecticut Children’s Medical Center and medical director of the Newtonville milk bank. The risk of necrotizing entercolitis, a particularly fearsome complication for preemies that destroys intestinal tissue, is reduced to near zero, she says. “They have better eyesight, fewer infections; they get out of the hospital faster, and they’re less sick in the first few years of life.’’

For James Hobbs, who got to bring Ryder to the family’s home in Ashby after a month in the neonatal intensive care unit, the donor breast milk had value that went far beyond price.

Worried that Ryder might be too cold in a chilly house, James cupped his hands over his infant son’s head on his first night at home.

“He laid on the bed with his hands on his head and just looked at him all night long,’’ Christine Hobbs said. “He did not sleep all night long. He just kept feeling him. He just watched him all night long.’’

Brenda Goodman can be reached at bkdgoodman@gmail.com.

Clarification: This story should have said that Paige Eastman Dickinson, a New Bedford mother, screens donors she finds on the Internet by obtaining blood test results indicating whether they are disease-free.

DONORS

Women who donate might have extra milk to give because their babies died, they may have been surrogate mothers, or they make more than their infants need. It is possible, in many cases, for a woman to maintain her supply as long as she keeps expressing it by pumping or nursing.

REGULATION

The US Food and Drug Administration does not regulate donor breast milk, but the agency recently held its first-ever meeting on the topic, and regulators say they are weighing whether or not more oversight of this growing trade is needed and if so, at what level — state or federal — that should be done.

MILK FOR SALE

One factor driving the FDA’s action is that milk is being sold. The California company Prolacta, in partnership with the drug company Abbott, sells products made from donated breast milk to hospital neonatal intensive care units. Their pasteurized breast milk costs $26 to $29 an ounce, about 6-to-10 times what a network of nonprofit milk banks charges for a similar amount.

THE DEMAND

The 10 nonprofit milk banks that self-regulate through the Human Milk Banking Association of North America, or HMBANA, told the FDA that they processed 1.5 million ounces of milk last year, but that the real need, if all neonatal intensive care units in the country used it, would be closer to 9 million ounces.

BRENDA GOODMAN