Attitudes of NICU professionals regarding feeding blood-tinged colostrum or milk

Abstract

Objective: Mothers of neonatal intensive care unit (NICU) patients sometimes bring expressed milk that is blood tinged to the NICU. In certain instances, the blood contamination appears minimal, whereas in others, the milk is quite dark pink. We have observed inconsistencies in practice regarding whether or not to feed blood-tinged colostrum or milk to NICU patients. We know of no evidence that establishes best practice in this area, and thus we sought to determine attitudes of NICU professionals on which to base a potentially best practice.Study Design: We conducted a web-based anonymous survey of attitudes of NICU professionals at Intermountain Healthcare regarding feeding blood-tinged expressed milk to NICU patients. These professionals included neonatologists, neonatal nurse practitioners, NICU nurses, NICU dieticians and lactation consultants.Result: Survey results were returned from 64% (426 of 667) of those to whom it was sent. A total of 75% of respondents reported that their practice was NOT to feed the blood-tinged milk illustrated in the figure as sample 2, and nearly all respondents (98%) reported that they would NOT feed the milk illustrated as sample 3. The majority of the neonatologists (56%) and the lactation consultants (58%) recommended feeding moderately bloody milk (sample 2), whereas only 22% of the neonatal nurse practitioners (NNPs), NICU nurses and NICU dieticians recommended feeding such samples (<0.001). The most frequently selected reason for NOT feeding blood-tinged milk was that it would likely cause gastrointestinal upset and feeding intolerance (selected by 77%). The majority (87%) overestimated the amount of blood contaminating a milk sample (sample 3). Conclusion:As colostrum and human milk feedings can be of value to NICU patients, evidence should be assembled to document whether feeding blood-tinged samples indeed have the problems listed by the survey respondents. Such evidence is needed to enable informed decisions involving the benefits vs risks of feeding blood-tinged expressed milk to NICU patients.

More on professionals’ attitudes on blood-tinged milk: a survey from Italy

“…We read with interest the only available papers on blood-tinged milk by Phelps et al 1,2 Although benefits of human milk (HM) to both healthy and high-risk infants are well known, 3 it is a common belief that blood-tinged milk may worsen gastrointestinal tolerance and, possibly, lead to unnecessary investigations for gastrointestinal bleeding or necrotizing enterocolitis. In their first work, Phelps et al 1 showed that the amount of blood necessary to tinge milk is very little, with a ratio of 1:10 000 between parts of red blood cells and milk to tinge it faintly pink, a ratio of 1:1000 to tinge it pink and of 1:100 to tinge it red.…”

“…In their first work, Phelps et al 1 showed that the amount of blood necessary to tinge milk is very little, with a ratio of 1:10 000 between parts of red blood cells and milk to tinge it faintly pink, a ratio of 1:1000 to tinge it pink and of 1:100 to tinge it red. They showed that 75% of neonatal intensive care unit professionals from 18 hospitals in the western United States would discard milk if pink, raising to 98% if red.…”

Feeding blood-tinged expressed mother's milk in the NICU

“…Very small amounts of mother's blood can result in pink or even red expressed mother's milk (1). In the NICUs of our healthcare system, and we suspect in many other NICUs as well, blood-tinged mother's milk is not fed, but is discarded.…”

“…In the February 2009 issue 1 we reported results of an e-survey of neonatal intensive care unit (NICU) professionals at Intermountain Healthcare regarding feeding NICU patients blood-tinged expressed mother's milk. We received 421 survey responses; 7% of respondents would discard the milk shown as #1 (faintly red breast milk), 75% would discard milk #2 and 98% would discard milk #3 (very red sample) (see Figure 1 in Phelps et al 1 ).…”

“…We received 421 survey responses; 7% of respondents would discard the milk shown as #1 (faintly red breast milk), 75% would discard milk #2 and 98% would discard milk #3 (very red sample) (see Figure 1 in Phelps et al 1 ). The reasons given most frequently for not feeding blood-tinged milk were; (1) It would cause gastrointestinal upset and feeding intolerance (77% of respondents), (2) blood might appear in the stool and result in Abbreviations: GI, gastrointestinal; NEC, necrotizing enterocolitis.…”