Donor human milk availability linked to increased breastfeeding, less NEC

Last Updated: 2016-02-24

By Anne Harding

NEW YORK (Reuters Health) - Neonatal intensive care units (NICUs) that begin offering donor human milk (DHM) see a drop in rates of necrotizing enterocolitis (NEC), according to new findings.

And while concerns had been raised that making donor milk available would lead to a decrease in maternal breast milk feeding, the opposite was true, Dr. Henry C. Lee of Stanford University and Lucile Packard Children's Hospital and colleagues report in a Pediatrics article online February 22.

Breast milk has a host of benefits for premature babies, with recent research linking it to lower rates of retinopathy of prematurity, NEC, sepsis and chronic lung disease. But it can be a huge challenge for mothers of preemies to breastfeed their babies, Dr. Lee told Reuters Health.

"Often those babies are not able to actually even try to breastfeed for several weeks, so mom has to pump with a breast pump up to eight times a day for quite a few weeks," he said.

Given the known benefits of breast milk and the difficulty new moms of preemies can face, an increasing number of NICUs are offering donor breast milk. In the United States and Canada, there are currently 24 milk banks accredited by the Human Milk Banking Association of North America.

To get a better sense of how DHM availability might affect outcomes for very low birthweight infants, Dr. Lee and his team looked at data from the California Perinatal Quality Care Collaborative (CPQCC) and the Mother's Milk Bank of San Jose for 2007 to 2013.

During the study period, the number of California hospitals making DHM available rose from 27 of 126 (21%) to 55 of 133 (41%). Increases were seen across all NICU types, but were most pronounced for regional NICUs. By 2013, 81.3% of premature infants were cared for at regional NICUs with DHM availability, versus 38.2% in 2007.

At the 22 hospitals that went through a clear transition to offering DHM from not offering it, the rate of breastfeeding at discharge increased by a mean 10 percentage points, while rates of NEC dropped an average of 2.6 percentage points.

After adjusting for risk, the researchers found lack of DHM availability was a significant predictor of NEC, with an odds ratio of 1.15.

The findings can't show that making DHM available reduced NEC, or increased rates of breastfeeding at discharge, Dr. Lee said. These changes are likely related to NICUs efforts to promote breast milk feeding in general, he added, which often include making DHM available.

"The big picture is not, 'Is it donor milk or is it mother's own milk?' The big picture is that breast milk makes a huge difference," Dr. Lydia Furman, a professor of pediatrics at Rainbow Babies and Children's Hospital in Cleveland, told Reuters Health. Dr. Furman wrote an editorial accompanying the study.

"One important finding is that when you make donor milk available, it doesn't mean that mothers throw in the towel," Dr. Furman added, noting that a 2013 study from Italy also found a link between DHM availability and increased breastfeeding rates.

In a CPQCC NICU quality improvement project that covers the study period and published elsewhere, Dr. Furman noted in her editorial, DHM availability was not directly addressed, "but it is likely that the advocacy, awareness, and education associated with such multifaceted breastfeeding promotion interventions have a ripple effect that opens the institutional door to a formal donor milk procurement policy."

SOURCE: bit.ly/1p3S5CF and bit.ly/1TyHnPH

Pediatrics 2016.