Breastfeeding is often considered the gold standard for infant nutrition, offering a range of benefits for both mothers and babies, particularly those born extremely preterm. However, circumstances may sometimes prevent mothers from being able to provide their own milk (MOM). In such cases, donor human milk (DHM) programs have been established to provide an alternative. A recent retrospective cohort study has sparked new discussion around the effectiveness and implications of these programs for MOM consumption and preterm infant care.
Keywords
1. Mother’s Own Milk (MOM)
2. Donor Human Milk (DHM) Program
3. Extremely Preterm Infants
4. Neonatal Intensive Care Unit (NICU)
5. Lactation Success Strategies
The study, published in The Journal of Pediatrics, aimed to compare the consumption of MOM by infants born extremely preterm before and after the implementation of a DHM program. The secondary objective was to assess healthcare providers’ knowledge and practices regarding DHM. Conducted by a team of experts across multiple health institutions, including Leslie A. Parker from the College of Nursing at the University of Florida, they recorded data from three distinct groups of infants born at <30 weeks of gestation across different time periods around the DHM program’s implementation.
Groups 1, 2, and 3 respectively represented infants before DHM, the first year following implementation, and the second year after implementation. The analysis of their feeds for six weeks post-birth found that Group 1 received a higher proportion of MOM than Group 3 in the initial weeks. Furthermore, Group 1 consumed 23.6% more MOM than Group 3 in the first 14 days and maintained a higher likelihood of consuming feeds with >90% MOM than the later groups.
One of the most notable findings was the decrease in MOM consumption following the DHM program implementation over two years. The study suggests that rather than complementing MOM, DHM may be supplanting it, which could undermine the benefits of mother’s milk that is crucial for the development of extremely preterm infants. The reasons behind the decline were not thoroughly investigated in this study; however, it raises questions about whether the availability of DHM could be impacting efforts to support and promote lactation among mothers in neonatal intensive care units (NICU).
The study also highlighted inconsistency in knowledge among healthcare providers when it comes to DHM. A significant number of respondents lacked adequate information to discuss the potential risks and benefits of DHM with mothers. This gap in knowledge and communication could affect decision-making and support for lactation among mothers of extremely preterm infants.
Lactation support remains a critical part of care in NICUs for both mothers and their preterm infants. The findings of the study point to the need for improved strategies to ensure successful lactation and increased MOM consumption. Although DHM is a valuable resource, it should not replace MOM unless absolutely necessary. Enhanced education for healthcare providers, consistent communication with mothers, and support systems such as lactation consultants could play a significant role in increasing MOM consumption post-implementation of DHM programs.
This research puts forward an imperative to balance the use of DHM with support for MOM, especially given the unique benefits of the latter, such as the presence of maternal antibodies and better digestive compatibility. As the study has shown a significant decline in MOM intake with the availability of DHM, it’s evident that new policies and practices may need to be established to protect and promote the use of MOM.
The DOI for the study is 10.1016/j.jpeds.2019.03.040, which provides a direct link for those in the scientific community to review the research and data in detail.
References
1. Parker, L. A., Cacho, N., Engelmann, C., Benedict, J., Wymer, S., Weaver, M., & Neu, J. (2019). Consumption of Mother’s Own Milk by Infants Born Extremely Preterm Following Implementation of a Donor Human Milk Program: A Retrospective Cohort Study. The Journal of Pediatrics, 211, 33-38. DOI: 10.1016/j.jpeds.2019.03.040
2. American Academy of Pediatrics. (2012). Breastfeeding and the Use of Human Milk. Pediatrics, 129(3), e827–e841. DOI: 10.1542/peds.2011-3552
3. Unger, S., Gibbins, S., Zupancic, J., & O’Connor, D. L. (2014). Do Practice Guidelines on the Use of Breast Milk and Donor Human Milk in the Neonatal Intensive Care Unit Make a Difference? Journal of Perinatology, 34(12), 917-920. DOI: 10.1038/jp.2014.125
4. Meier, P. P., Johnson, T. J., Patel, A. L., & Rossman, B. (2013). Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants: An Expert Review. Clinics in Perinatology, 40(1), 1-22. DOI: 10.1016/j.clp.2012.12.002
5. Underwood, M. A. (2013). Human Milk for the Premature Infant. Pediatric Clinics of North America, 60(1), 189-207. DOI: 10.1016/j.pcl.2012.09.008
As preterm births remain a challenge in neonatal care, studies such as Parker et al.’s provide a basis for re-evaluating current practices and ensuring that the health benefits MOM offers are not overshadowed by the logistical ease of using DHM. This work may act as a stepping stone for future research and policy-making aiming to improve neonatal health outcomes.