PC1114: Impact of Donor Human Milk in an Urban NICU Population

Background: The American Academy of Pediatrics recommends the use of donor human milk in infants when mother’s own milk is not available. Numerous studies have demonstrated the benefits of donor human milk particularly in preterm infants, including decreased rates of infection, necrotizing enterocolitis (NEC), feeding intolerance, morbidity, and mortality. Despite the well documented effects of human milk, studies show ethnic and socio-economic discrepancies with regards to both awareness and acceptance of its use. In our pre-dominantly African American inner-city population, we found that only 34% of mothers were aware of donor breast milk and 62% preferred formula over human milk. There is a dearth of data on the use of donor human milk in populations with traditionally low exclusive breast-feeding rates ( < 20%).

Methods: We conducted a retrospective cohort study comparing two epochs of VLBW neonates before and after the introduction of donor breast milk (DBM) in our neonatal intensive care unit (NICU). The rates of NEC, duration of parenteral nutrition use, number of days to return to birth weight, length of hospital stay (LOS) and mortality were compared for an equal numbers of infants for 2 years prior to and after the transition to donor milk. The transitional year was excluded in the analysis. For infants who developed NEC, we compared the severity based on the modified Bell staging criteria, and prognosis between the two epochs.

Results: Demographic and clinical characteristics were similar in both groups (gestational age 27.6 vs 27.47; p= 0.19 and birth weight 964 vs 982g; p= 0.39 in the pre-DBM and post-DBM groups respectively). After the introduction of donor breast milk there was a significant reduction in the rate of NEC (11% vs 14%, p=.006) and less severe NEC (1.9% vs 4%) as defined by Stage 3b based on the Modified Bell Staging Criteria. In the donor milk era, there was early initiation of enteral feeding (2.69 days vs 3.84; p= .006) and earlier return to birthweight (9.5d vs 10.9d; p= .006). Additionally, the post-DBM cohort had a shorter LOS (61d v 66d; p= 0.5) and a trend towards lower mortality (6% vs 18%; p 0.065), though these results were not statistically significant.

Conclusion: In this retrospective study, a practice change to the use of donor breast milk in a population with low exclusive breastfeeding rates promoted early initiation of enteral feeding and faster return to birth weight. It also reduced the incidence of NEC and may lead to lower mortality and morbidity. Further study in this population is warranted.