Human Milk Banks Come Back, but Questions Remain : Health: Many shut down after AIDS became prevalent; eight now serve 2,000 infants a year. Processing reduces risks but saps nutrition.

BOSTON —  Rhiannon Greywolf owes her life to Sara Leicht, but the two have never met. Leicht’s breast milk, donated through a human milk bank in Worcester, has helped keep 16-month-old Rhiannon alive.

“She would have been in a hospital without the milk bank,” said the girl’s mother, Linda Greywolf of Colchester, Conn.

She said her daughter is allergic to cow and goat milk and to all commercial baby formulas. Greywolf, 45, is unable to produce enough milk on her own to feed her baby.

“I thought, I have all this milk and I might as well donate it to these poor little babies who need it,” said Leicht, 34.

There are eight milk banks in the United States and Canada. They only feed about 2,000 babies a year, but human milk bank advocates say their services save lives.

“As smaller and sicker babies are saved, there is more need for a specific food for them,” said Mary Rose Tully, director of the milk bank at Wake Medical Center in Raleigh, N.C. “The least difficult thing for them to digest is human milk.”

In addition to Raleigh and Worcester, milk banks also operate in Denver; San Jose, Calif.; Washington; Lexington, Ky.; Wilmington, Del.; and Vancouver, British Columbia.

The first milk bank in the United States opened in the early 1900s in Boston. By the 1970s, there were more than 30 banks across the country. Improving medical technology enabled doctors to save earlier premature babies, and milk from the banks nourished them.

In the 1980s, commercial formula companies developed formulas specifically for premature babies, reducing the demand for bank milk. Then came AIDS.

Worried about the possibility of HIV, the virus that causes AIDS, being transmitted through a donor’s milk, most of the country’s milk banks shut down. Most doctors stopped prescribing donor milk.

“HIV was the nail in the coffin for a lot of milk banks,” said Lois Arnold, director of the Human Milk Banking Assn. of North America.

In 1985, the association developed strict guidelines for milk banks. Milk donors are screened in the same way that blood donors are. They have to fill out questionnaires, undergo blood tests and not be in a high-risk group for AIDS or other diseases such as hepatitis. The donated milk is heat-treated to kill any viruses that may have slipped through and then frozen, to be thawed when needed.

Now the milk is available only by prescription.

Most specialists agree that processing reduces the likelihood of transmitting disease, but the heating and freezing also destroys some of the milk’s most valuable qualities.

“There is probably a retention of about 50% of the beneficial properties,” said Miriam Erikson, director of the milk bank at the Medical Center of Central Massachusetts in Worcester.

“We’re between a rock and a hard place. Doctors are afraid to use the milk unpasteurized, but they also say that heat-treated milk doesn’t do any good,” she said.

The Canadian Pediatric Society is unconvinced about the benefits of milk banks and is preparing to recommend that doctors not use them.

“When we added the possible benefits and the possible shortcomings, we felt, at least in 1995 in Canada, we would not recommend the use of human donor milk,” said Dr. Stanley Zlotkin, chairman of the society’s Nutrition Committee and a professor at Toronto’s Hospital for Sick Children.

While stressing that the society strongly favors mothers breast-feeding their own babies, Zlotkin said there was no hard scientific evidence suggesting that treated, donated milk was better than formulas. In addition, he said, there was some risk of passing on milk-borne diseases--although he said there were no documented cases of disease being transmitted through bank milk.

Milk bank advocates say donated milk, even if it has been treated, can prevent some common diseases among premature babies. One killer illness is necrotizing enterocolitis, a disease that destroys sections of the baby’s intestines. Research shows that human milk reduces the incidence of the disease.

“For premature babies, the optimal is a mixture of human milk and formula,” said David S. Newburg, a scientist at Boston’s Shriver Center for Mental Retardation who studies the materials in human milk that protect against disease.

“I think milk banks are important” as a way of providing milk for premature infants who need it, he said.