DONOR HUMAN MILK PROGRAM

Implementation of a Donor Human Milk Program in a Neonatal Intensive Care Unit



ABSTRACT

The feeding of human milk (milk from the infant's own mother; excluding donor milk) during the newborn intensive care unit (NICU) stay reduces the risk of costly and handicapping morbidities in premature infants. The mechanisms by which human milk provides this protection are varied and synergistic, and appear to change over the course of the NICU stay. The fact that these mechanisms include specific human milk components that are not present in the milk of other mammals means that human milk from the infant's mother cannot be replaced by commercial infant or donor human milk, and the feeding of human milk should be a NICU priority. Recent evidence suggests that the impact of human milk on improving infant health outcomes and reducing the risk of prematurity-specific morbidities is linked to specific critical exposure periods in the post-birth period during which the exclusive use of human milk and the avoidance of commercial formula may be most important. Similarly, there are other periods when high doses, but not necessarily exclusive use of human milk, may be important. This article reviews the concept of "dose and exposure period" for human milk feeding in the NICU to precisely measure and benchmark the amount and timing of human milk use in the NICU. The critical exposure periods when exclusive or high doses of human milk appear to have the greatest impact on specific morbidities are reviewed. Finally, the current best practices for the use of human milk during and after the NICU stay for premature infants are summarized.

TABLE OF CONTENTS

ABSTRACTii

Introduction1

Critical Exposure Periods for the Use of Human Milk3

Early Enteral Feedings: Transition from Colostrum to Mature Milk During the First Month Post-Birth7

Dose of Human Milk During the NICU Stay8

The Impact of Human Milk Feedings after the NICU Stay13

Providing Cost-Effective, Expert Lactation and Human Milk Feeding Support for Families and Staff in the NICU18

Conclusion22

References23

Implementation of a Donor Human Milk Program in a Neonatal Intensive Care Unit

Introduction

Research, practice, and quality improvement initiatives focused on the use of human milk in the NICU have been limited by the lack of a precise, quantitative measure of “human milk feeding” for premature infants. Whereas definitions for “breastfeeding” were standardized for term healthy infants in the early 1990s, these six categorical definitions do not capture the critical components of human milk feeding patterns for NICU infants. Additionally, the existing definitions for “human milk feeding” used in studies of premature infants are limited and inconsistent. For example, human milk feeding might vary from receiving “any” human milk to having received a specific volume threshold, such as 50 mL/kg/day. However, the measures usually do not specify when the infant received human milk and whether there were periods of exclusive or high doses of human milk feeding. Thus, quality improvement initiatives that focus only on increasing the percentage of NICU infants that are “human milk-fed” will be inadequate if specific amounts and time periods of human milk feeding are ...