Pasteurized Donor Human Milk in Healthy Newborns
by Anne Eglash MD, IBCLC, FABM
Many newborn infants do not have access to 100% mother’s milk, due to several factors. For example, mothers may have insufficient glandular tissue with very low colostrum volumes or have a delay in their milk ‘coming in’, while others may have undergone breast reduction or mastectomy. Some newborns are prone to neonatal hypoglycemia due to maternal diabetes, late preterm status, etc.
In order to maximize breast milk feedings during newborn hospitalization, many hospitals have opted to purchase pasteurized DHM to supplement otherwise well newborns when mother’s own milk is not sufficient or available.
The author for this week’s article gathered policies from 15 Northeastern US hospitals to explore eligibility to receive DHM for healthy newborns, how the milk is used, and how lactation is supported.
- Most policies included educating mothers on how to establish her milk supply.
- All policies required consent for DHM use.
- All policies included history of breast surgery as eligibility criteria for DHM.
- Neonatal hypoglycemia was the most common eligibility criterion for DHM.
- Most considered a mother’s intent to provide breastmilk in the eligibility criteria for DHM.
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Background and Objectives
Providing pasteurized donor human milk (DHM) to healthy newborns is an emerging practice. The content of hospital policies that govern this practice is unknown.
Materials and Methods
We collected policies from 15 Northeast U.S. hospitals through (1) a 2017 survey on DHM use and (2) an e-mail listserv of levels 1 and 2 newborn care staff maintained by a regional milk bank. Two authors reviewed each policy and identified how they addressed three predetermined themes: who is eligible to receive DHM, how DHM is used and described, and how lactation is supported. Responses were compared, discussed, and reconciled. Level 1 newborn care was defined as basic care for healthy newborns ≥35 weeks' gestation.
Thirteen of 15 policies stated criteria for DHM eligibility, most commonly as a bridge until mother's supply comes in (73%) or for infant medical conditions (67%). All required consent for DHM. Most did not limit number of days infants could receive DHM (60%). Nine specified that DHM be discarded 24 hours after thaw, whereas five recommended discarding at 48 hours. Although many (53%) policies endorsed human milk as the preferred diet for newborns, only 27% specifically endorsed DHM as the preferred supplementation type. Parent education (73%) was emphasized, but few (27%) discussed the importance of establishing mother's milk supply.
Many DHM policies address eligibility criteria for receiving DHM and show how to provide DHM, but few address how to support lactation while DHM is provided, which may be crucial for optimizing long-term breastfeeding outcomes.
According to the authors of this study, most policies did not address how to support lactation while DHM was provided, and they pointed out the need to do so in their conclusion. The eligibility criteria for DHM varied among hospitals, and among the 15 policies evaluated, only 1 included a history of breast surgery as a criterion.
This study did not evaluate the main driver for instituting the use of DHM for well newborns, but the authors implied in their background that DHM use allows hospitals to increase their exclusive breastmilk feeding rates at discharge, which is a measure tracked by Baby Friendly Hospital Initiative and The Joint Commission.
Another good reason for the use of DHM for infants whose mothers intend to exclusively breastfeed is the higher risk of cow’s milk allergy among exclusively breastfed infants supplemented with cow’s milk formula during the first 3 days of life. The evidence for this has been increasing, including a new study from Japan. Infants whose mothers do not intend to breastfeed exclusively or at all have a significantly lower risk of cow’s milk allergy due to repeated exposure to cow’s milk formula early in life.