With the recent National Association of Neonatal Nurses (NANN) conference, there are several timely neonatal care topics that I could write about. Perhaps some of those will come later! For today, the issue of providing breast milk for newborns and particularly for premature infants is the topic I’d like to focus on.
The reason I chose this topic is because there is hard evidence now that breast milk improves so many outcomes, particularly for the high risk premature infant. While challenges remain, we owe it to these infants to address these challenges and figure out how to get the best breast milk to them. More and more hospitals are now joining the effort to provide exclusive breast milk for these infants. The high risk population that most benefits from exclusive breast milk is the premature infant born at less than 1500 grams. This is not to infer in any way that older infants do not benefit greatly from exclusive breastfeeding. But the medical benefits for premature infants are significant.
Neu & Walker (2011) estimated a rate of NEC of 7% in infants between 500 and 1500 gm birthweight. The mortality rate is stated as 20-30% in these infants with higher mortality in infants who require surgery. In a study by Sullivan et al (2010), NEC rates were significantly decreased when the infant was fed an exclusively human milk diet, although rates were higher than many hospitals to begin with. This study even had one group in which the infant’s diets were fortified only with human/human milk fortifier so there was no exposure to bovine proteins. Besides NEC, this has also been associated with allergies later in life. This group had the most improvement in NEC rates.
While exclusive breastfeeding is the goal, it is not always possible to get sufficient breast milk when the mother must pump all the breast milk to be fed to the infant. Particularly, the first feedings can be challenging when sufficient milk is not yet available or in cases when the infant requires long term tube feedings, necessitating long term pumping. So, in that case, how do we provide breast milk to the premature infant in the most critical stage, the first few feedings? Many hospitals are now providing donor milk for this purpose. Discussion has occurred recently regarding the cost of donor milk and how this is absorbed or passed on. Efforts are underway to get donor milk reimbursement from insurance companies, particularly in this high risk population. If NEC is indeed avoided with the use of even exclusive donor milk, the cost of care overall is much lower. According to one estimate from chart reviews, estimates of cost for surgical NEC show an average of $186,200 and medical NEC averages $73,700 per patient (Bisquera, 2002). Note that this article was published in 2002 and these costs may be significantly higher today. Donor milk can be purchased for $3/ounce plus shipping (Mother’s Milk Bank, San Jose, CA). While the use of donor milk solves the issue of availability of milk early enough to meet the needs of these high risk infants, a note of caution is needed. There should never be an assumption or belief that donor milk can take the place of mother’s own milk. Mother’s own milk is more nutritionally adequate for the infant, contains appropriate antibodies and other nutritional advantages over donor milk. The lesson is that donor milk is superior to formula or artificial milk. So, the first choice, whenever possible is to use mother’s own milk, then donor milk when that is not available.
In addition to the benefits and use of donor milk in our NICU’s, encouraging mothers who have extra milk for whatever reason to donate to the milk banks ensures that the milk will be available for infant’s whose mother’s cannot provide the milk they need. Mothers who have lost their infants or surrogates who are not providing milk to the infant should be referred to the milk bank. Even if the milk bank is not local, arrangements can be made to send the milk long distances and maintain safety.
There are so many benefits to the use of human milk in infants overall, this blog only touches on one such benefit. Here is a web link that may be useful to you and your families when discussing the benefits of breast milk.