Impact of donor milk availability on breastmilk use and necrotizing enterocolitis rates | LATCH

Author: Tamyra Rae Hoff, RN, MS, NE-BC

It has been well established that human milk is the optimal form of nutrition for all infants and it is even more important for preterm infants to receive the short- and long-term benefits of human milk feedings. There are a great number of studies such as the 2016 Kantorowska study1 reporting that the use of human milk for the very low birth weight infant (VLBW) can decrease multiple complications associated with prematurity such as necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP) and sepsis.

Unfortunately, breastfeeding can be very challenging for mothers of premature infants due to the lack of skin-to-skin contact, prolonged pumping requirements and the complex nature of the neonatal intensive care unit (NICU). Kantorowska’s retrospective and descriptive analysis looked at how donor human milk (DHM) availability affects breastfeeding rates and NEC rates in VLBW infants.

Some clinicians falsely assume that having donor milk available decreases the number of mothers who breastfeed their infants because there is an alternative. Combining data from the California Perinatal Quality Care Collaborative (CPQCC) and the Mother’s Milk Bank of San Jose (MMB), researchers examined 22 NICUs in California that brought DHM into practice.

The CPQCC collects information on the care of over 90% of infants in the NICU and during the study period from 2007 to 2013, there were 42,532 VLBW infant records available to review. The study found increased availability of DHM across all levels of NICU units in California, with the greatest change occurring in NICUs that provide the highest level of care.  After evaluating the impact of acquiring DHM, there was a clear association with a decrease in NEC rates and an increase in the rates of breastfeeding infants at discharge. Access to DHM was associated with a 10% increase in breastfeeding at discharge and a 2.6% decrease in the hospital rate of NEC. In theory, DHM could potentially give mothers an alternative avenue to obtain the benefits of human milk feedings without the stress of attempting to provide their own milk as the only form of nutrition.2

However, based on the results of the Kantorowska study, it appears that the availability of DHM could foster a breastfeeding-friendly environment in which mothers may be more encouraged to breastfeed or pump. These results suggest that the availability of DHM in a hospital is linked to better outcomes for VLBW infants treated in the NICU. The use of DHM should be considered a quality improvement initiative that NICUs can undertake as a part of their broader strategies to improve nutrition for preterm infants.

References

1. Kantorowska, A. W. Impact of donor milk availability on breast milk use and necrotizing enterocolitis rates. Pediatr. 2016; 137(3), 1-8.
2. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk [published online February 27, 2012]. Pediatr. doi:10.1542/peds.2011-3552