The Current State of Donor Human Milk Use and Practice

Abstract

Human milk contains nutrients and immune factors that promote health and growth of an infant. Donor human milk is recommended as the best alternative for infants whose mothers’ breast milk is unavailable. This article describes the current status of donor human milk practice and suggests the areas of educational and research needs. Articles published in the last 10 years were reviewed, and findings were summarized under 4 themes: (1) women's knowledge and concerns about donor human milk use, (2) hospital practices, (3) cost‐effectiveness, and (4) access and affordability of donor human milk. Women were concerned about donor human milk contamination, disease transmission, cost, and access to bank donor human milk, due to lack of knowledge and awareness of donor human milk benefits and its processing procedures. The absence of health care providers’ support for donor human milk adds to the confusion. There is a rising trend of donor human milk use in hospitals for both healthy and vulnerable newborns and infants with varying policies on screening for donor human milk use, cost coverage, or consent procedure. However, a shortage of safe and affordable donor human milk is a barrier to its adoption. A standardized guideline is needed for hospitals regarding donor human milk implementation and cost coverage. Education programs for health care providers are needed to improve knowledge and understanding of donor human milk benefits and safety to provide guidance to parents. It is crucial to develop legislation expanding insurance coverage to achieve donor human milk equity and optimizing long‐term human milk diet outcomes.

Inequities Among Hospital Donor Human Milk Access

“…While California has covered the use of DHM through MediCAL since 1998, it is only is speci c situations and there are still additional costs associated with providing DHM that the hospital incurs such as milk storage, preparation time, and licensing [30]. Many reports indicate that the use of DHM lowers overall medical costs in the long run [10,11,17,20,29,31]. However, nancially constrained institutions might feel required to respond to short-term direct costs rather than longterm cost savings [32].…”

Donor Human Milk Use in Advanced Neonatal Care Units — United States, 2020

“…Most hospitals access donor milk from banks accredited by the nonprofit Human Milk Banking Association of North America, with 28 member milk banks currently operating in 25 states. §§ Availability of donor milk at hospitals might be affected by supply from milk banks, cost, and reimbursement, which can vary by state and payment source ( 6 ). Milk bank supply is in turn affected by barriers persons might face when considering milk donation, such as lack of knowledge about milk banking and beliefs about acceptability of donation ( 7 ).…”

“…When donor milk is available, additional hospital- and individual-level factors might affect how often it is used. These include lack of standardized policies and staff member training related to donor milk use, as well as staff member and parent knowledge and perceptions about the health benefits and safety of donor milk ( 6 ).…”

“…include lack of standardized policies and staff member training related to donor milk use, as well as staff member and parent knowledge and perceptions about the health benefits and safety of donor milk (6).…”

Supporting Families Facing Lactation Anaphylaxis: A Case Report

“…Hospital initiatives for the use of donor milk for both vulnerable and healthy infants require infrastructure for a consistent supply of inpatient donor milk. 11 In the case of lactation anaphylaxis, the birthing person should be counseled on the pros and cons of continued breastfeeding attempts, as well as potential options for medication management. Supplementation may be necessary during the initial period of symptom control and early milk production, in which case the family should have access to donor milk if desired.…”