Mother’s Own Milk Versus Donor Milk

 

It no longer remains a question about whether breast milk is best for babies. If anyone has doubts, there are multiple sources and examples of how breast milk is better for all babies, but particularly for our premature infants in the NICU.

There have been other blogs detailing all the advantages of mother’s own milk for premature babies. As we learn more and more about these advantages, which sometimes make big differences in survival, some may match these advantages to use of donor milk since it is also human milk. However, studies have not yet proven that donor milk has the same advantages as mother’s own milk.

We know that premature babies do not grow as well when fed donor milk compared to formula feeding, although nutrient supplementation of donor milk compared to formula has not been well studied1.  And if the nutrition in donor milk is inadequate for physical growth, what about brain growth? Does this nutrition, or lack of it, impact neurodevelopmental outcome?

While some studies have shown a decrease in the incidence of necrotizing enterocolitis with the use of donor milk over formula, this is also true of mother’s own milk, and even more convincing1,2.

Donor Milk Costs

I have participated in efforts to bring donor milk to the NICU in two different hospitals over recent years.  Of course, in the current healthcare environment, a cost-benefit analysis is required to get anything new available for use in the hospital. The cost of donor milk can be prohibitive in this environment.

The cost of the actual milk is just one part of the overall cost. Most milk banks sell the milk at a price to break even, but their costs must be covered. This results in a cost of about $1 – $2 per ounce. In some places, this may be covered by insurance, but that cost is also passed on to the medical consumer.

For some states, there is the additional cost of a tissue license since donor milk may be classified as human tissue. This could be around $1,000 per year. Whether controlled under a tissue bank license or not, additional expenses are incurred through shipping and record-keeping costs. Some may argue that this is worthwhile if even one case of necrotizing enterocolitis can be avoided, both from a cost and humanitarian perspective. I would agree, but mother’s own milk is less costly and has the same or better advantages to decrease the risk of necrotizing enterocolitis.

So, while donor milk may be an attractive alternative to mother’s own milk, it is certainly no replacement!

Supporting Milk Production

We are left with the importance of helping mothers establish and maintain their own milk supply. This starts with pumping within the first hour after delivery or sooner, if possible. Some may believe this to be too stressful for the mother, but imagine if you had just delivered a very premature baby who had been taken away for intensive care. You are unable to see your infant and so are stressed already. At least pumping early reassures you that you are able to provide something very important to that infant.

Furthermore, providing moms with a diary of milk production and reviewing it whenever they visit helps identify when production may be starting to fall off. If this is identified early and tips are given about increasing frequency of pumping, improving food and water intake, making sure to get enough rest and others, production can be increased before it falls to dangerous levels or disappears altogether. This also helps send a message to moms that we appreciate the work they put into pumping and to reinforce how important this is, not only for the first week or two of the infant’s life, but ongoing throughout their NICU stay and after.

Should our resources be directed toward supporting the production of mother’s own milk? Possibly providing more education, time, and support for the bedside nurse to properly prepare them to provide this? How about making more lactation educators/counselors available? Or providing more/better breast pumps?

Or should those resources be devoted to getting donor milk into the unit? Certainly, if resources are available for both, great! But given a choice, it seems promoting the production and collection of mother’s own milk is the better solution, and even when available, donor milk should never be viewed as a replacement for mothers’ own milk.

References:

1. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants.  Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No: CD002/14651858.CD002971.pub3.

2. Schanler RJ. The use of human milk for premature infants. Pediatr ClinNorth Am. 2001;48:207–219