Update on Questions Regarding Journal of Human Lactation Article Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic

A recent controversy regarding an article about the handling of human milk containers during the COVID-19 pandemic has raised important concerns from readers of the Journal of Human Lactation.

We hope that the following helps answer some of your questions and guide your next steps as a skilled lactation provider.

What is the article about?

The Journal of Human Lactation recently published a series of articles related to COVID-19, including the “Insights into Practice and Policy” article Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic, by Kathleen A. Marinelli, MD, IBCLC, FABM, FAAP and Robert M Lawrence, MD, FABM, FAAP.

This article highlights that, at the time of publication, there is no evidence of the COVID-19 virus in human milk. It also notes that, at the time of publication, no guidance had been published concerning the disinfection of the outer surfaces of containers of expressed milk during the COVID-19 pandemic. [editor’s note: since the time of publication, the Human Milk Bank of North America (HMBANA) has released a set of guidelines, which can be found here.]

The article makes recommendations for milk expression and for the disinfection of containers of expressed milk.

What is the concern?

Following publication of the article, HMBANA shared concerns that the recommendations were “created and published without the involvement of milk banking and food safety experts.” In particular, HMBANA’s statement expressed objections to the author’s recommendations for disinfection that they describe as exceeding “FDA’s legal limit for food manufacturers.” HMBANA called for the retraction of the article.

How has ILCA addressed this concern?

First, some background: in order to ensure that scientific journals can operate as freely as possible from non-scientific concerns, they typically operate separately from their professional organization. The Journal of Human Lactation (JHL) is no exception. ILCA provides operating support to the JHL and extends subscriptions to JHL to its members. ILCA does not oversee JHL staff and exerts no influence over the content of the articles.

That being said, ILCA heard HMBANA’s concerns and took them seriously. ILCA reached out to both JHL and JHL’s publisher, not to influence the content, but with the goal of ensuring a thorough and transparent review of HMBANA’s concerns.

How has the Journal of Human Lactation addressed these concerns?

Discussions and disputes about scientific research and commentaries are not uncommon. The discussion that result are, in fact, a part of the process that brings us the best possible thinking in lactation research.

However, when there is a concern that there may be a risk to human health, or a dispute in a time of emergency such as the COVID-19 pandemic, sharing information quickly about the difference of opinion is paramount. Scientific journals, including JHL, have a process in place for moments such as these.

The JHL editor-in-chief has released an Editor’s note, which alerts the scientific community to the presence of a concern. The JHL has published two letters outlining some of the concerns, which can be found here and here. The article authors have also been given the opportunity to respond here. (Note that the articles and the responses either are or will be open source as soon as possible.)

What resources are available to my health care facility for decision-making about our policy regarding the handling of human milk?

First and foremost, it is important to note that there continues to be no evidence of the COVID-19 virus in breastmilk. 

ILCA has made available on our COVID-19 page the milk-banking guidelines from HMBANA as well as a statement from the European Milk Bank Association. In addition to the robust conversation referenced in this post, JHL has also made available a letter sharing the experience of an Italian donor milk program, which can be found here.

In the face of the rapidly changing information regarding COVID-19, ILCA will continue to share guidelines, resources, and information here. We welcome your suggestions of additional resources to share with the ILCA community. Please share updates to media@Ilca.org.

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