Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant: Clinical Report

Mother's own milk (MOM), appropriately fortified, provides optimal nutrition for hospitalized very low birth weight (VLBW [≤1500 g]) infants in the neonatal intensive care unit (NICU) and confers a myriad of other short- and long-term health benefits. Every family of a VLBW infant should receive information about the critical importance of MOM to the health of their infants and receive intensive support throughout the full course of their infant's hospitalization to achieve their personal lactation goals. Provision of pasteurized donor human milk (PDHM) is recommended when MOM is not available, insufficient in volume, or is contraindicated. PDHM should optimally be continued until the infant's risk to develop necrotizing enterocolitis is low (approximately 34-36 weeks' postmenstrual age). Preterm infant formula is recommended when MOM is not available and PDHM is either not available or the family declines use. Promotion of human milk and breastfeeding for VLBW infants requires access to efficient, effective, and comfortable double electric breast pumps in the hospital and at home and multidisciplinary and system-wide adoption of lactation support practices, including early and frequent milk expression, skin-to-skin care (SSC), and direct breastfeeding. Addressing social inequities in provision of human milk at the local level requires access to PDHM, peer lactation support, maximizing use of interpreter services as appropriate, and implementation of standardized approaches to identify and address unmet basic needs.