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Stinson LF, Ma J, Lai CT, Rea A, Perrella SL, Geddes DT. Milk microbiome transplantation: recolonizing donor milk with mother's own milk microbiota. Appl Microbiol Biotechnol 2024; 108:74. [PMID: 38194146 PMCID: PMC10776751 DOI: 10.1007/s00253-023-12965-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 01/10/2024]
Abstract
Donor human milk (DHM) provides myriad nutritional and immunological benefits for preterm and low birthweight infants. However, pasteurization leaves DHM devoid of potentially beneficial milk microbiota. In the present study, we performed milk microbiome transplantation from freshly collected mother's own milk (MOM) into pasteurized DHM. Small volumes of MOM (5%, 10%, or 30% v/v) were inoculated into pasteurized DHM and incubated at 37 °C for up to 8 h. Further, we compared microbiome recolonization in UV-C-treated and Holder-pasteurized DHM, as UV-C treatment has been shown to conserve important biochemical components of DHM that are lost during Holder pasteurization. Bacterial culture and viability-coupled metataxonomic sequencing were employed to assess the effectiveness of milk microbiome transplantation. Growth of transplanted MOM bacteria occurred rapidly in recolonized DHM samples; however, a greater level of growth was observed in Holder-pasteurized DHM compared to UV-C-treated DHM, potentially due to the conserved antimicrobial properties in UV-C-treated DHM. Viability-coupled metataxonomic analysis demonstrated similarity between recolonized DHM samples and fresh MOM samples, suggesting that the milk microbiome can be successfully transplanted into pasteurized DHM. These results highlight the potential of MOM microbiota transplantation to restore the microbial composition of UV-C-treated and Holder-pasteurized DHM and enhance the nutritional and immunological benefits of DHM for preterm and vulnerable infants. KEY POINTS: • Mother's own milk microbiome can be successfully transplanted into donor human milk. • Recolonization is equally successful in UV-C-treated and Holder-pasteurized milk. • Recolonization time should be restricted due to rapid bacterial growth.
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Affiliation(s)
- Lisa F Stinson
- School of Molecular Sciences, The University of Western Australia, Perth, Australia.
| | - Jie Ma
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Perth, Australia
| | - Sharon L Perrella
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Perth, Australia
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2
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Anstey E, Noiman A, Boundy E, Nelson J. Maternity care practices supportive of breastfeeding in U.S. advanced neonatal care units, United States, 2022. J Perinatol 2024; 44:1560-1566. [PMID: 39375497 DOI: 10.1038/s41372-024-02139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 09/26/2024] [Accepted: 09/30/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVE To describe breastfeeding-supportive practices in U.S. maternity hospitals with advanced neonatal care units (ANCU). STUDY DESIGN Using 2022 mPINC data, we calculated the percent of hospitals reporting (1) breastfeeding-supportive practices for "most" (≥80%) mother-baby dyads in ANCUs, by hospital demographic characteristics and (2) infant receipt of mother's own milk or donor milk at any time while in the ANCU, by ANCU level. RESULTS More than 90% of hospitals reported that "most" mothers (≥80%) were advised on some breastfeeding-supportive practices. Fewer hospitals reported that "most" mothers expressed milk within one hour of birth (37%) or that kangaroo care was practiced for "most" eligible newborns (63%). Receipt of mother's own milk varied by unit level and state. CONCLUSION Breastfeeding-supportive practices requiring the technical competency of healthcare providers (e.g., early milk expression, kangaroo care) are less likely to be implemented in ANCU settings compared to practices centered around providing advice or education.
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Affiliation(s)
- E Anstey
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - A Noiman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - E Boundy
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
| | - J Nelson
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. Public Health Service Commissioned Corps, Rockville, MD, USA
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3
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Parker LA. Use of Donor Human Milk in Populations Other than Preterm Very Low Birthweight Infants: Where Are We Now? J Perinat Neonatal Nurs 2024; 38:238-240. [PMID: 39074319 DOI: 10.1097/jpn.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
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McClintock T, Fiddes C, Harris S, Embleton N, Lin L, Bloomfield FH, Muelbert M. Donor human milk versus infant formula for low-risk infants: a systematic review. Pediatr Res 2024:10.1038/s41390-024-03309-x. [PMID: 38844541 DOI: 10.1038/s41390-024-03309-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 09/08/2024]
Abstract
BACKGROUND There is an increasing acceptance and use of donor human milk (DHM) in healthy infants. This review investigates the benefits and risks of mothers' own milk (MOM) supplementation with DHM compared to infant formula (IF) in moderate-late preterm (MLP) and early term (ET) infants. METHODS MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and clinical trial registries were searched for studies published up to September 2023. The primary outcome was rates of exclusive breastfeeding (EBF). Certainty of evidence was assessed using GRADE framework. RoB1 and EPHPP were used to assess risk of bias for controlled trials and observational studies, respectively. RESULTS Eleven studies involving total of 10,147 infants and six ongoing trials were identified. Studies were of low quality, and the certainty of evidence was assessed as very low. Three studies suggested benefits of DHM compared to IF on EBF at discharge, while two suggested no difference. No clear effect was observed on EBF duration, any breastfeeding, hypoglycemia and morbidity. No health risks were reported. CONCLUSION The effect of supplementing MOM with DHM instead of IF on EBF and other health outcomes is unclear. High-quality studies are required to determine the potential benefits or risks of DHM supplementation in this population. IMPACT We identified 11 relevant studies reporting on supplementation of mothers' own milk (MOM) with donor human milk (DHM) compared to infant formula (IF). Studies were of low quality, had heterogeneous outcome definitions and were geographically limited; all except two were observational studies. Limited evidence showed no clear difference on rates of exclusive breastfeeding and other health outcomes. No potential risks were reported. The increasing acceptance and use of DHM in healthy infants highlights the need for future high-quality studies.
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Affiliation(s)
| | - Catherine Fiddes
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Shalee Harris
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Nicholas Embleton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Mariana Muelbert
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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Davis JA, Glasser M, Spatz DL, Scott P, Demirci JR. First Feed Type Is Associated With Birth/Lactating Parent's Own Milk Use During NICU Stay Among Infants Who Require Surgery. Adv Neonatal Care 2022; 22:578-588. [PMID: 35421040 PMCID: PMC9556699 DOI: 10.1097/anc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associated with longer duration of B/LPOM use for infant feedings in healthy term and hospitalized preterm infants. This relationship has not been explored in infants undergoing neonatal surgery (surgical infants). PURPOSE To evaluate the relationship between early exclusive B/LPOM feeds and cumulative B/LPOM patterns during surgical infants' neonatal intensive care unit (NICU) hospitalization. METHODS A secondary cross-sectional analysis was performed using the electronic health record data of surgical infants admitted to a level IV NICU between January 2014 and March 2015. Multiple linear regression and Fisher's exact test were used to examine the associations between first NICU feed type and total percentage of diet composed of B/LPOM during NICU stay and continuation of any or exclusive B/LPOM feedings at NICU discharge, respectively. RESULTS The analysis included 59 infants who required surgery for gastrointestinal, cardiac, or multisystem defects or pregnancy-related complications. Receipt of B/LPOM as the first NICU feed was associated with higher percentage of B/LPOM feeds ( P < .001) throughout NICU stay, as well as continuation of any or exclusive B/LPOM feedings at NICU discharge ( P = .03). IMPLICATIONS FOR PRACTICE Early exclusive B/LPOM feeds may be an important predictor for continuation of any B/LPOM use throughout the NICU stay and at NICU discharge. Continued efforts to identify and address gaps in prenatal and postpartum lactation support for parents of surgical infants are needed. IMPLICATIONS FOR RESEARCH Powered studies are needed to corroborate these findings and to explore the potential impact of other factors on duration and exclusivity of B/LPOM use. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .
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Affiliation(s)
- Jessica A Davis
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Ms Davis and Drs Glasser, Scott, and Demirci); and University of Pennsylvania School of Nursing, Philadelphia, and The Children's Hospital of Philadelphia (CHOP), Philadelphia, and Children's Hospital of Philadelphia's Mothers' Milk Bank, Philadelphia, Pennsylvania (Dr Spatz)
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Pylypjuk C, Bokhanchuk A, Day C, ElSalakawy Y, Seshia MM. Antenatal breastfeeding promotion amongst pregnancies at high-risk for newborn admission to the NICU: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol X 2022; 15:100160. [PMID: 35864932 PMCID: PMC9294247 DOI: 10.1016/j.eurox.2022.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives To determine the prevalence and factors associated with antenatal promotion of breastfeeding in high-risk pregnancies. Study design This was a cross-sectional study of trends in breastfeeding promotion during antenatal consultation of pregnancies at high-risk for newborn admission to the neonatal intensive care unit (NICU) between January 2017 and December 2020. Eligible high-risk pregnant patients undergoing antenatal consultation in a tertiary-level fetal assessment unit were identified using an electronic clinic repository. Consult letters and fetal assessment reports were reviewed to determine baseline demographics, pregnancy history, fetal findings, and communication about breastfeeding. Descriptive and inferential statistics were used to present findings and compare outcomes between groups. Results 316 pregnancies were included for final analysis. The mean maternal age was 28.7 years (SD 6.2) and 65 % were multiparas. Median gestational age at time of antenatal consult was 32 weeks [IQR 29–34]. The main indication for consultation was fetal anomalies (72.8%), namely cardiac defects (21.2 %). There was a significant improvement in prevalence of antenatal discussions about breastfeeding over the study period, from 48.8 % early in the study period compared to 73.7 % in the past year (p = 0.036). However, amongst consults where breastfeeding was discussed, almost one-quarter (23.8 %) of patients indicated that they were not planning on breastfeeding postnatally. Conclusion There has been a significant improvement in promoting breastfeeding antenatally amongst high-risk pregnancies. However, no follow-up or supports were offered to one-quarter of patients who indicated no intention of breastfeeding or using donor milk postnatally. Ongoing work is required to further advance breastfeeding promotion antenatally, increase parental supports and education, and optimize breastfeeding rates postnatally for improving outcomes of this high-risk group. While there has been a significant improvement in antenatal breastfeeding promotion amongst high-risk pregnancies, it is still missing in almost one-quarter of patients. There are no obvious demographic or clinical differences between high-risk patients that received antenatal breastfeeding promotion versus those that did not, suggesting that a more standardized approach to antenatal discussions about infant feeding could improve breastfeeding success in the NICU. Ongoing work is required to further improve breastfeeding promotion antenatally along with additional postnatal supports to enhance breastfeeding success.
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Affiliation(s)
- Christy Pylypjuk
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Correspondence to: WN5002 HSC Women’s Hospital, 820 Sherbrook Street, Winnipeg, MB, Canada R3A 1R9.
| | - Anna Bokhanchuk
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Day
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yasmine ElSalakawy
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary M. Seshia
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York.,New York City Health+Hospitals Elmhurst
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8
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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding, or the provision of human milk, a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention (CDC) and The Joint Commission monitor breastfeeding practices in US hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York.,New York City Health+Hospitals/Elmhurst
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9
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Gray K, Ryan S, Churchill M, Harder VS. The Association Between Type of Supplementation in the Newborn Nursery and Breastfeeding Outcomes at 2 and 6 Months of Age. J Hum Lact 2022; 39:245-254. [PMID: 35730582 DOI: 10.1177/08903344221105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Supplementation in the newborn nursery has been associated with shorter breastfeeding duration. However, supplementation may at times be necessary. RESEARCH AIM To determine the association between type of supplementation in the newborn nursery (mother's own milk, formula, donor human milk) and breastfeeding outcomes at 2 and 6 months of age. METHODS This was a prospective, longitudinal, observational multi-group cohort study. In total, 2,343 surveys were sent to parents who, prior to delivery, indicated intent to exclusively breastfeed. Participants were grouped by type of nursery supplementation. Surveys asked about breastfeeding outcomes when infants were 2 and 6 months old. Our final analytic sample included data from 1,111 healthy newborns ≥ 35 weeks. We used multiple logistic regression to compare future breastfeeding outcomes for infants who were exclusively directly breastfed or who received supplementation during their birth hospitalization. RESULTS Both the donor human milk and formula groups had decreased breastfeeding at 2 and 6 months compared to the exclusively directly breastfed group. Notably, for infants who received formula compared to donor human milk, the odds of breastfeeding at 2 and 6 months were 74% and 58% lower, respectively (OR = 0.26, 95% CI [0.12, 0.56] at 2 months; OR = 0.42, 95% CI [0.19, 0.94] at 6 months). The donor human milk group had lower odds of breastfeeding at both follow up times compared to the mother's own milk group. CONCLUSION Among those who intend to breastfeed, supplementation with donor human milk instead of formula in the newborn nursery may support longer breastfeeding.
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Affiliation(s)
- Karin Gray
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA.,The University of Vermont Children's Hospital, University of Vermont Medical Center, Burlington, VT, USA
| | - Stephanie Ryan
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA.,Legacy Randall Children's Hospital, Portland, OR, USA
| | - Martha Churchill
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Valerie S Harder
- The Robert Larner, M. D. College of Medicine, University of Vermont, Burlington, VT, USA
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10
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Riley J, Cherkerzian S, Benjamin C, Belfort MB, Sen S, Drouin K, Gregory K. Clinical Characteristics and Breastfeeding Outcomes in Term Dyads Following In-Hospital Supplementation with Pasteurized Donor Human Milk or Formula. Breastfeed Med 2021; 16:717-724. [PMID: 33872065 DOI: 10.1089/bfm.2020.0337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Pasteurized donor human milk (PDHM) supplementation for healthy infants is an emerging practice. Little is known about demographics or breastfeeding outcomes for dyads whose mothers choose PDHM versus formula. Research Aims: To identify relationships between in-hospital supplementation choice and (1) dyad characteristics and breastfeeding intent, and (2) breastfeeding outcomes at 1 month. Materials and Methods: This exploratory prospective cohort study surveyed healthy dyads requiring medically indicated supplementation. Participants completed questionnaires including demographics, breastfeeding intent, and self-efficacy during hospitalization, and self-efficacy and lactation outcomes at 1 month. Results: Of 39 participants, 24 (62%) supplemented with formula and 15 (38%) with PDHM. Formula dyads were more likely than PDHM dyads to have a delivery body mass index (BMI) ≥30 kg/m2 (58% versus 20%, p = 0.02), and less likely to have attained greater than a college degree (33% versus 7%, p = 0.02); formula dyads also reported lower breastfeeding intent scores (12.0 versus 15.5, p = 0.002). Breastfeeding self-efficacy scores were similar but decreased for both groups over 1 month. At 1 month, mothers who chose formula were more likely to continue to provide breast milk to their infants (84% versus 72%). Direct breastfeeding rates were similar (72% versus 68%); of participants directly breastfeeding at 1 month, PDHM dyads were 1.5 times more likely to provide maternal expressed milk. Conclusions: Differences in maternal education, BMI, and breastfeeding intent were found between feeding groups. Results suggest an association between PDHM choice and initial breastfeeding intent and breastfeeding self-efficacy and provision of maternal expressed milk at 1 month.
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Affiliation(s)
- Jennifer Riley
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charis Benjamin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katherine Gregory
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, USA
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11
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McCune S, Perrin MT. Donor Human Milk Use in Populations Other than the Preterm Infant: A Systematic Scoping Review. Breastfeed Med 2021; 16:8-20. [PMID: 33237802 DOI: 10.1089/bfm.2020.0286] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Exclusive breastfeeding is recommended for an infant's first 6 months of life. If unable to breastfeed, expressed breast milk, including donor human milk (DHM), is recommended for optimal nutrition. Benefits of DHM in preterm infants have been established by extensive research. However, less is known about DHM use in other populations. Objective: To conduct a scoping review of the literature regarding DHM use in populations other than preterm infants. Materials and Methods: PubMed and Clinicaltrials.gov were used to search for articles and clinical trials published between January 1, 2000 and February 29, 2020. In total, 182 articles and reports were identified and screened by 2 independent reviewers. Results: Twenty-six articles met inclusion criteria and were reviewed. Studies were mostly observational in design and included infants born >35 weeks gestational age with health risks (9/26) and healthy infants (14/26). Most studies in infants with health risks (7/9) investigated clinical outcomes, with small, observational studies suggesting potential improvements in feeding tolerance and gastrointestinal health. Regarding healthy infants, no studies addressed growth, only one study measured clinical outcomes, and findings related to breastfeeding outcomes were conflicting. Over half of the studies reviewed (15/26) were not designed to establish a potential relationship between DHM use and relevant health-related outcomes. Conclusion: The current evidence of DHM use in populations other than preterm infants is limited by lack of direct health measures and infrequent use of randomized trials. More research is warranted to investigate clinical, growth, and breastfeeding outcomes.
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Affiliation(s)
- Sydney McCune
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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12
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Kair LR, Nidey NL, Marks JE, Hanrahan K, Femino L, Fernandez Y Garcia E, Ryckman K, Wood KE. Disparities in Donor Human Milk Supplementation Among Well Newborns. J Hum Lact 2020; 36:74-80. [PMID: 31770064 PMCID: PMC7015767 DOI: 10.1177/0890334419888163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Donor human milk supplementation for healthy newborns has increased. Racial-ethnic disparities in supplementation have been described in the neonatal intensive care unit but not in the well newborn setting. RESEARCH AIM The aim of this study was to identify maternal characteristics associated with donor human milk versus formula supplementation in the well newborn unit. METHODS This retrospective cohort study includes dyads of well newborns and their mothers (N = 678) who breastfed and supplemented with formula (n = 372) or donor human milk (n = 306) during the birth hospitalization at a single hospital in the midwestern United States. Maternal characteristics and infant feeding type were extracted from medical records. Chi-square and logistic regression were used to examine associations between maternal characteristics and feeding type. RESULTS Nonwhite women were less likely to use donor human milk. Compared to non-Hispanic white women, the largest disparity was with Hispanic (adjusted odds ratio [OR] = 0.28, 95% CI [0.12, 0.65]), then non-Hispanic black (adjusted OR = 0.32, 95% CI [0.13, 0.76]) and Asian women (adjusted OR = 0.34, 95% CI [0.16, 0.74]). Lower donor human milk use was associated with primary language other than English and public versus private insurance. CONCLUSION The goal of improving public health through breastfeeding promotion may be inhibited without targeting donor human milk programs to these groups. Identifying the drivers of these disparities is necessary to inform person-centered interventions that address the needs of women with diverse backgrounds.
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Affiliation(s)
- Laura R Kair
- University of California, Davis, Sacramento, CA, USA.,University of Iowa, Iowa City, IA, USA
| | - Nichole L Nidey
- University of Iowa, Iowa City, IA, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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13
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Drouin KH, Riley JF, Benjamin C, Gregory KE, Sen S, Belfort MB. Donor Milk Policies for Level 1 Newborn Care: A Descriptive Analysis. Breastfeed Med 2019; 14:592-596. [PMID: 31393161 DOI: 10.1089/bfm.2019.0094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and Objectives: Providing pasteurized donor human milk (DHM) to healthy newborns is an emerging practice. The content of hospital policies that govern this practice is unknown. Materials and Methods: We collected policies from 15 Northeast U.S. hospitals through (1) a 2017 survey on DHM use and (2) an e-mail listserv of levels 1 and 2 newborn care staff maintained by a regional milk bank. Two authors reviewed each policy and identified how they addressed three predetermined themes: who is eligible to receive DHM, how DHM is used and described, and how lactation is supported. Responses were compared, discussed, and reconciled. Level 1 newborn care was defined as basic care for healthy newborns ≥35 weeks' gestation. Results: Thirteen of 15 policies stated criteria for DHM eligibility, most commonly as a bridge until mother's supply comes in (73%) or for infant medical conditions (67%). All required consent for DHM. Most did not limit number of days infants could receive DHM (60%). Nine specified that DHM be discarded 24 hours after thaw, whereas five recommended discarding at 48 hours. Although many (53%) policies endorsed human milk as the preferred diet for newborns, only 27% specifically endorsed DHM as the preferred supplementation type. Parent education (73%) was emphasized, but few (27%) discussed the importance of establishing mother's milk supply. Conclusions: Many DHM policies address eligibility criteria for receiving DHM and show how to provide DHM, but few address how to support lactation while DHM is provided, which may be crucial for optimizing long-term breastfeeding outcomes.
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Affiliation(s)
- Kaitlin H Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer F Riley
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Charis Benjamin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Katherine E Gregory
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Ferrarello D, Schumacher A, Anca R. Nurse-Driven Initiative to Increase Exclusive Human Milk Feeding by Using Pasteurized Donor Human Milk to Treat Hypoglycemic Term Neonates. Nurs Womens Health 2019; 23:316-326. [PMID: 31251932 DOI: 10.1016/j.nwh.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/10/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To increase exclusive breastfeeding by offering pasteurized donor human milk (PDHM) to newborns with hypoglycemia. DESIGN Quality improvement project. SETTING/LOCAL PROBLEM A Baby-Friendly Hospital Initiative-designated urban academic medical center in the northeastern United States serving a diverse population where, by policy, virtually all newborns with hypoglycemia received supplemental infant formula. Approximately 85% of women cared for at this center initiate breastfeeding, but many struggle with exclusive breastfeeding during the hospital stay. PARTICIPANTS All staff members in the labor and delivery unit and the mother/baby unit, including registered nurses, unit clerks, patient care technicians, and lactation consultants. Term, breastfed newborns identified as being hypoglycemic per our guidelines were eligible to receive PDHM. INTERVENTION/MEASUREMENTS Registered nurses provided education about PDHM to parents of newborns who were hypoglycemic, obtained consent, and initiated the order. We offered PDHM instead of infant formula when mother's own milk was not available in sufficient quantity per our hypoglycemia guidelines. We measured newborns' glucose levels and monitored breastfeeding outcomes, including continued breastfeeding. RESULTS During the 4-month trial, 83 newborns were eligible for PDHM. Of those, 76% of parents opted for PDHM rather than formula. Most newborns in both groups were still breastfeeding at discharge, and 53% of those who received PDHM were fed human milk exclusively during their hospital stays. CONCLUSION A nurse-driven protocol offering PDHM to otherwise healthy newborns with hypoglycemia is a viable option for increasing exclusive breast milk feeding during the hospital stay.
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Nurses' Views on Using Pasteurized Donor Human Milk for Hypoglycemic Term Infants. MCN Am J Matern Child Nurs 2019; 44:157-163. [PMID: 30882766 DOI: 10.1097/nmc.0000000000000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore maternal child nurses' knowledge and beliefs about using pasteurized donor human milk (PDHM) to treat newborns with hypoglycemia. Pasteurized donor human milk has been used for decades in neonatal intensive care units, but its use is relatively new in the well-baby population. STUDY DESIGN AND METHODS Focus groups of maternal child nurses were conducted to explore this topic. RESULTS Six focus groups that included a total 20 nurses were held. Four themes were identified: 1) nurses presumed safety of PDHM but lacked knowledge, 2) nurses' role as patient-family advocate, 3) nurses' logistical concerns about implementation of PDHM, and 4) nurses lacked clarity on formal milk sharing versus PDHM. CLINICAL IMPLICATIONS As the use of PDHM increases for well babies, nurses will need more education about PDHM, its safety profile, its use in breastfeeding support and protection of the infant microbiome, and how PDHM differs from informal milk sharing. Nurses play an important role in helping parents weigh risks and benefits of using PDHM or formula when supplementation is needed during the hospital stay. It is important that nurses feel confident in their own knowledge and ability to address parental concerns so they can advocate for their patients and support parental decision-making.
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Spatz DL. Pasteurized Donor Human Milk and Milk Banking Through the Human Milk Banking Association of North America. J Obstet Gynecol Neonatal Nurs 2018; 47:545-546. [PMID: 29481772 DOI: 10.1016/j.jogn.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 10/17/2022] Open
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