A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding

Abstract

Despite decades of breastfeeding promotion, exclusive breastfeeding rates for the first 6 months of life remain low: around 40% globally. Infants that are admitted to a neonatal ward are even less likely to be exclusively breastfed. Lactogenesis is frequently delayed in mothers that deliver early, with the added burden of separation of the unstable newborn and mother. For such vulnerable infants, donor human milk is recommended by the World Health Organization, UNICEF, and professional organizations as the next best alternative when mother's own milk is unavailable and can serve as a bridge to full feeding with mother's own milk. Hospital support of optimal breastfeeding practices is essential with thoughtful integration of donor human milk policies for those infants that need it most. We propose a decision tree for neonatal wards that are considering the use of donor human milk to ensure donor human milk is used to replace formula, not to replace mothers' own milk. By first evaluating barriers to full feeding with mother's own milk, healthcare workers are encouraged to systematically consider the appropriateness of donor human milk. This tool also seeks to prevent overuse of donor human milk, which has the potential to undermine successful lactation development. In settings where donor human milk supplies are limited, prioritization of infants by medical status is also needed. Readily available and easy-to-use tools are needed to support healthcare staff and mothers in order to improve lactation development and neonatal nutrition.

Questionnaire on the breastfeeding and the donation of 70 mothers\donors.

“…The second question about the reason of the donation is the altruism which is prevailing in 83,3% of answers. This datum is in line with the literature [19][20][21][22][23][24][25][26][27][28][29] and is a positive one even if we consider it together with the abundance of milk produced (23%), because it sheds light on mothers' sensitivity regarding pre-term babies; we should encourage them through information campaigns on this reality which is little known by the public opinion except for anecdotal cases that get into papers, media and on the Net.…”

Quality management in Human Milk Banks: a scope review

“…This method is an initial component of the quality process approach; its application requires compliance with all steps, otherwise the varied practice will compromise its effectiveness as a method of improvement (37) . The use of these tools for changes in practices proved to be a successful strategy to increase the rates of breast milk use in premature newborns (38)(39) .…”

The use of human donor milk

“…25 30 Box 2: How to prepare frozen pasteurised donor milk for feeding 1 13 25 • Defrost donor milk containers slowly over 24 Encourage mothers of infants in a neonatal intensive care unit to express breast milk as soon as they can. 19 Once infants can coordinate sucking, swallowing, and breathing (around 32-34 gestational weeks), mothers can trial direct breastfeeding. 31 In cases where mothers are unable to breastfeed, pasteurised donor milk can be provided beyond hospital discharge.…”

“…If a mother’s own milk is not available, breastfeeding is contraindicated, or an infant’s mother is unable to provide sufficient quantities of her own breast milk after being provided with lactation support, pasteurised donor milk is indicated as a first alternative for any infant ( box 1 ). 2 13 19 25 Infants with severe medical conditions, premature infants, or very low birthweight babies (<1500 g) are prioritised when demand for donor milk exceeds supply. 2 13 19 Parental consent is typically required before the use of donor milk in most human milk banks, including those from Brazil, France, India, and North America.…”