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Donor Human Milk Use in Advanced Neonatal Care Units - United States, 2020
Ellen O Boundy1, Erica H Anstey1, Jennifer M Nelson1
1Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC.
Insights
Pasteurized donor human milk is crucial for very low birthweight (VLBW) infants when mother's milk is unavailable. While many VLBW infants receive donor milk, some hospitals still face barriers to its provision.
Area of Science:
- Neonatal care
- Infant nutrition
- Public health
Background:
- Very low birthweight (VLBW) infants (<1,500 g) face significant health risks.
- Human milk, including pasteurized donor milk, offers protective benefits against conditions like necrotizing enterocolitis, sepsis, and neurodevelopmental impairment.
- Donor milk is the recommended alternative when mother's own milk is insufficient for VLBW infants.
Purpose of the Study:
- To assess the availability and utilization of pasteurized donor human milk for VLBW infants in U.S. advanced neonatal care units.
- To identify factors associated with donor milk availability in these units.
Main Methods:
- The study utilized data from the CDC's 2020 Maternity Practices in Infant Nutrition and Care (mPINC) survey.
- Practices regarding donor milk use were analyzed among 616 hospitals with level III or IV neonatal intensive care units.
Main Results:
- 13.0% of surveyed hospitals reported that donor milk was unavailable for VLBW infants.
- Approximately 54.7% of hospitals reported that most (≥80%) VLBW infants received donor milk.
- Donor milk availability was higher in level IV units, hospitals with higher birth volumes, those in the Midwest and Southwest, nonprofit and teaching hospitals, and Baby-Friendly designated facilities.
Conclusions:
- While donor milk is increasingly available, barriers to its provision persist for some VLBW infants.
- Addressing these barriers is crucial to ensure VLBW infants receive essential donor milk, potentially reducing morbidity and mortality.
- Optimizing donor milk access can improve health outcomes for vulnerable VLBW populations.
Abstract:
Approximately 50,000 infants are born in the United States each year with very low birthweight (VLBW) (<1,500 g).* Benefits of human milk to infants with VLBW include decreased risk for necrotizing enterocolitis, a serious illness resulting from inflammation and death of intestinal tissue that occurs most often in premature infants, especially those who are fed formula rather than human milk; late-onset sepsis; chronic lung disease; retinopathy of prematurity; and neurodevelopmental impairment (1). When mother's own milk is unavailable or insufficient, pasteurized donor human milk (donor milk) plus a multinutrient fortifier is the first recommended alternative for infants with VLBW (2). CDC's 2020 Maternity Practices in Infant Nutrition and Care (mPINC) survey was used to assess practices for donor milk use in U.S. advanced neonatal care units of hospitals that provide maternity care (3). Among 616 hospitals with neonatal intensive care units (level III or IV units),† 13.0% reported that donor milk was not available for infants with VLBW; however, approximately one half (54.7%) reported that most (≥80%) infants with VLBW do receive donor milk. Donor milk availability for infants with VLBW was more commonly reported among hospitals with a level IV unit, higher annual birth volume, location in the Midwest and Southwest regions, nonprofit and teaching status, and those designated Baby-Friendly.§ Addressing hospitals' barriers to providing donor milk could help ensure that infants with VLBW receive donor milk when needed and help reduce morbidity and mortality in infants with VLBW (1,4).
