Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants

Abstract

Background Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. Methods We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 – December 2019) (n = 101) and during the pandemic (March 2020 – December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother’s need for psychological support during NICU stay and the duration of psychological follow-up after discharge. Results In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. Conclusion Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.

No change in mother's own milk provision and breastfeeding rates in preterm infants during the COVID‐19 pandemic

“…MOM feeding and breastfeeding rates at discharge were similar between time periods. The study from Italy cited above had nearly the same results concerning the rate of breastfeeding at discharge in VLBW infants (73.3% vs. 72.7%) 17 . Studies analysing healthy neonates found lower breastfeeding rates, more breastfeeding difficulties, and increased rates of mixed feeding during the pandemic 15 …”

“…18 In contrast to this result, an Italian study found a decrease of expressed maternal milk during the pandemic (86.1% before the pandemic vs. 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement in VLBW infants with an unchanged rate of formula-fed infants owing to the availability of donor milk. 17 MOM feeding and breastfeeding rates at discharge were similar between time periods. The study from Italy cited above had nearly the same results concerning the rate of breastfeeding at discharge in VLBW infants (73.3% vs. 72.7%).…”

“…However, infants with birth weight <1000 g were three times less likely to receive any MOM at discharge compared to those with a birth weight of >2500 g. Furthermore, mothers with a low deprivation index were more likely to be feeding MOM at NICU discharge 18 . In contrast to this result, an Italian study found a decrease of expressed maternal milk during the pandemic (86.1% before the pandemic vs. 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement in VLBW infants with an unchanged rate of formula‐fed infants owing to the availability of donor milk 17 …”

“…Several reports found a marked decrease in breastfeeding rates of healthy neonates born during the pandemic, 15 while studies on the provision of MOM for preterm infants in NICUs had inconsistent results. Infants born <34 weeks of gestation 16 suffered no consequences in MOM provision while in other studies analysing VLBW infants 17 and infants <1000 g 18 the availability of MOM decreased. Only few studies provided data on the impact of the pandemic on the provision of MOM to high‐risk preterm infants.…”

“…The study from Italy cited above had nearly the same results concerning the rate of breastfeeding at discharge in VLBW infants (73.3% vs. 72.7%). 17 Studies analysing healthy neonates found lower breastfeeding rates, more breastfeeding difficulties, and increased rates of mixed feeding during the pandemic. 15 The unaltered duration of MOM provision, feeding type and breastfeeding rates may be linked to our visiting policy right from the start of the pandemic.…”