Understanding the current and future usage of donor human milk in hospitals: An online survey of UK neonatal units

Disparities in being able to donate human milk impacts upon maternal wellbeing: Lessons for scaling up milk bank service provision

Receiving donor human milk for a baby can have a protective effect upon parental wellbeing. A growing body of research also finds that being able to donate milk to a milk bank, particularly after infant loss, can also boost maternal wellbeing through feelings of altruism and purpose. However, most studies are qualitative, with small sample sizes outside the United Kingdom, and often do not include the experiences of those who have been unable to donate. Our aim was therefore to examine the impact of being able to donate milk, as well as the impact of not being able to do so, using a survey containing open and closed questions in a large UK sample. Overall, 1149 women completed the survey, 417 (36.3%) who donated their milk and 732 (63.7%) who did not. Most women who donated found it had a positive impact upon their wellbeing, feeling proud, useful and that they had achieved something important. Conversely, those unable to donate often felt rejected, frustrated, and excluded, especially if they received no response or felt that restrictions were unfair. Thematic analysis found that being able to donate could help women heal from experiences such as birth trauma, difficult breastfeeding experiences, neonatal unit stays, and infant loss; however, being unable to donate could exacerbate negative emotions arising from similar experiences. A minority of women who donated experienced raised anxiety over following guidelines. These findings further extend the impacts of milk banking services beyond infant health and development and support expanded service delivery.

Receiving screened donor human milk as part of a community-based lactation support programme reduces parental symptoms of anxiety and depression

Infant feeding decisions and maternal mental health are closely tied. Donor human milk (DHM) protects premature infant health and development and can reduce hospital stays. Recent qualitative research has highlighted that having the option for an infant to receive DHM can also support parental wellbeing through reducing concerns about infant health and supporting feeding preferences. However, no quantitative study has examined this relationship. In this study, anxiety and depression scores were measured before and after receiving DHM using the Hospital Anxiety and Depression Scale for 80 parents (77 mothers, 3 fathers) who had sought DHM from a community-facing milk bank. Reasons for seeking DHM included maternal cancer, maternal and infant health complications, insufficient glandular tissue, and low milk supply. Open-ended questions explored the experience of receiving milk. Milk bank records were used to match details of milk given (volume, duration, exclusivity, lactation support given) with survey responses. Both anxiety and depression scores significantly reduced after receiving milk. Although greater lactation support and longer duration of milk predicted a greater decrease in scores, in a regression analysis, only volume of milk given remained a significant predictor. Almost all parents agreed that being able to access DHM supported their wellbeing predominantly through reducing anxieties around infant health but also through feeding choices being respected and the support given at difficult times. The findings add important considerations to the literature considering when and for whom DHM should be used and the complex interplay between infant feeding and mental health.

Cost of operating a human milk bank in the UK: a microcosting analysis

ObjectiveGlobally, demand for donor human milk (DHM) is increasing with WHO guidelines recommending DHM as the first line nutrition for premature infants in the absence or shortfall of maternal milk. Policymakers and clinicians currently have limited knowledge regarding costs incurred by human milk banks (HMBs) making the planning and resourcing of these services challenging. This study aimed to evaluate costs in a national network of HMBs in the UK.

DESIGN AND SETTING

All 14 UK HMBS were invited to complete a bottom-up microcosting survey from 1 April 2021 to 31 March 2022 covering four key areas: Staffing, equipment, donor screening and incidental costs. Total annual salary costs included on-costs (ie, national insurance, pensions), qualifications, overheads (ie, non-staff costs) and capital overheads. The annual equivalent costs for each equipment item were based on the total cost over its useful life and discounted at 3.5%.

RESULTS

10 out of 14 milk banks provided responses with more complete datasets returned by larger milk banks. Staffing costs ranged from £24 983 to £476 194 (n=9, mean: £159 798) and considerable expertise was provided voluntarily or from non-costed staffing. Other costs included equipment (n=7, range: £2600-£51 453, mean: £19 279), donor screening (n=6, range: £925-£38 057, mean: £18 570), incidentals (n=6, range: £650-£109 996, mean: £23 774). The total annual cost of operating a milk bank annually was £202 719 (range, £27 583-£675 699) to provide between 205 and 3495 litres of DHM. The cost per litre averaged £173.49 (range, £95.94-£274.88).

CONCLUSIONS

The average cost of DHM is currently higher than current cost recovery tariffs and this study likely under-represents total costs. This study provides useful benchmarking data for future economic analyses, trial development and service planning.

Donor human milk for preventing necrotising enterocolitis in very preterm or very low-birthweight infants

BACKGROUND

When sufficient maternal milk is not available, donor human milk or formula are the alternative forms of enteral nutrition for very preterm or very low-birthweight (VLBW) infants. Donor human milk may retain the non-nutritive benefits of maternal milk and has been proposed as a strategy to reduce the risk of necrotising enterocolitis (NEC) and associated mortality and morbidity in very preterm or VLBW infants.

OBJECTIVES

To assess the effectiveness of donor human milk compared with formula for preventing NEC and associated morbidity and mortality in very preterm or VLBW infants when sufficient maternal milk is not available.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Maternity and Infant Care (MIC) database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), from the earliest records to February 2024. We searched clinical trials registries and examined the reference lists of included studies.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing feeding with donor human milk versus formula in very preterm (< 32 weeks' gestation) or VLBW (< 1500 g) infants.

DATA COLLECTION AND ANALYSIS

Two review authors evaluated the risk of bias in the trials, extracted data, and synthesised effect estimates using risk ratio, risk difference, and mean difference, with associated 95% confidence intervals. The primary outcomes were NEC, late-onset invasive infection, and all-cause mortality before hospital discharge. The secondary outcomes were growth parameters and neurodevelopment. We used the GRADE approach to assess the certainty of the evidence for our primary outcomes.

MAIN RESULTS

Twelve trials with a total of 2296 infants fulfilled the inclusion criteria. Most trials were small (average sample size was 191 infants). All trials were performed in neonatal units in Europe or North America. Five trials were conducted more than 40 years ago; the remaining seven trials were conducted in the year 2000 or later. Some trials had methodological weaknesses, including concerns regarding masking of investigators and selective reporting. Meta-analysis showed that donor human milk reduces the risk of NEC (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.37 to 0.76; I² = 4%; risk difference (RD) -0.03, 95% CI -0.05 to -0.01; 11 trials, 2261 infants; high certainty evidence). Donor human milk probably has little or no effect on late-onset invasive infection (RR 1.12, 0.95 to 1.31; I² = 27%; RD 0.03, 95% CI -0.01 to -0.07; 7 trials, 1611 infants; moderate certainty evidence) or all-cause mortality (RR 1.00, 95% CI 0.76 to 1.31; I² = 0%; RD -0.00, 95% CI -0.02 to 0.02; 9 trials, 2116 infants; moderate certainty evidence).

AUTHORS' CONCLUSIONS

The evidence shows that donor human milk reduces the risk of NEC by about half in very preterm or VLBW infants. There is probably little or no effect on late-onset invasive infection or all-cause mortality before hospital discharge.

A systematic review of contaminants in donor human milk

Donor human milk (DHM) from a milk bank is the recommended feeding method for preterm infants when the mother's own milk (MOM) is not available. Despite this recommendation, information on the possible contamination of donor human milk and its impact on infant health outcomes is poorly characterised. The aim of this systematic review is to assess contaminants present in DHM samples that preterm and critically ill infants consume. The data sources used include PubMed, EMBASE, CINAHL and Web of Science. A search of the data sources targeting DHM and its potential contaminants yielded 426 publications. Two reviewers (S. T. and D. L.) conducted title/abstract screening through Covidence software, and predetermined inclusion/exclusion criteria yielded 26 manuscripts. Contaminant types (bacterial, chemical, fungal, viral) and study details (e.g., type of bacteria identified, study setting) were extracted from each included study during full-text review. Primary contaminants in donor human milk included bacterial species and environmental pollutants. We found that bacterial contaminants were identified in 100% of the papers in which bacterial contamination was sought (16 papers) and 61.5% of the full data set (26 papers), with the most frequently identified genera being Staphylococcus (e.g., Staphylococcus aureus and coagulase-negative Staphylococcus) and Bacillus (e.g., Bacillus cereus). Chemical pollutants were discovered in 100% of the papers in which chemical contamination was sought (eight papers) and 30.8% of the full data set (26 papers). The most frequently identified chemical pollutants included perfluoroalkyl substances (six papers), toxic metal (one paper) and caffeine (one paper). Viral and fungal contamination were identified in one paper each. Our results highlight the importance of establishing standardisation in assessing DHM contamination and future studies are needed to clarify the impact of DHM contaminants on health outcomes.

Unlocking the Potential: A Systematic Literature Review on the Impact of Donor Human Milk on Infant Health Outcomes

Human mother milk is considered the most healthy and best source of nutrition for both premature and full-term infants, as it possesses many health benefits and is associated with its consumption. Some of the mothers are not able to produce an adequate quantity of milk to meet the required needs of the infants, particularly in cases involving premature births or facing challenges in breastfeeding. Especially for the most vulnerable premature infants, donor human milk (DHM) provides a helpful bridge for effective breastfeeding. Even with the advancement in baby formulas, no other dietary source can match the bioactive matrix of benefits found in human breast milk. This literature review discusses the risks associated with prematurity and explores the use of DHM in the care of premature infants. It helps prevent substantial preterm complications, especially necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis, which are more commonly seen in infants who are given formulated milk made from cow's milk. It gives insights into the benefits of DHM, such as immunological and nutritional benefits, which is a basic infant's need. When medical distress prevents mothers from producing enough breast milk for their infants, pasteurized human donor breast milk should be made accessible as an alternative feeding option to ensure infants remain healthy and nourished. A systematic literature search was conducted using PubMed and Google Scholar databases and other sources. A total of 104 articles were searched, of which 35 were included after identification, filters were applied, eligibility was checked, and references out of scope were excluded. Human milk banking should be incorporated into programs encouraging breastfeeding, highlighting lactation in mothers and only using DHM when required.