Donor Human Milk and Mothers' Own Milk: Why are Outcomes Different for VLBW Infants?

Paula Meier PhD, RN, FAAN


  • Description
  • Credit Hours
  • Outline

Description

Description

Donor human milk (DHM) has quickly become the international standard for feeding very low birthweight (VLBW; <1500 grams) infants during the NICU hospitalization when mothers' own milk (MOM) is not available.  Surprisingly little evidence supports this rapid change and recent systematic reviews reveal that DHM does not provide the same protection from morbidities as MOM and does not support optimal weight gain in recipient infants.  Nonetheless, multiple studies and quality improvement projects continue to combine MOM and DHM into the same feeding metric, "human milk feeding" as if the two types of milk were equivalent.  The purpose of this presentation is to review the evidence about health and cost outcomes for MOM and DHM, detail mechanisms that impact these differences in outcome and propose specific opportunities to translate these differences into best NICU practices.

Objectives:

  • Delineate differences among mothers' own milk (MOM), DHM and formula with respect to health outcomes and cost for VLBW infants.
  • Describe differences between MOM and DHM that are not pasteurization-dependent or that are "cumulative" with pasteurization and other differences, including: preterm versus term human milk; stage of lactation; impact of repeated freeze-thaw cycles, and the effect of human milk handling and fortification in the NICU.
  • Cite limitations in the use of "human milk feeding" terminology that combines DHM and MOM into the same outcome variable or quality indicator.
  • Translate research about the impact of DHM on MOM provision in the NICU to family-focused messaging and consent processes in the NICU.    

    

Duration
1 Hour 0 Minutes
Course ID
1310031W

Credit Hours

  • Nursing - 1.0 Contact Hours

Outline

  1. Differences in outcomes for MOM, DHM and formula for hospitalized VLBW infants
     -  Health outcomes, including NEC, late onset sepsis, bronchopulmonary dysplasia, ROP, neurodevelopmental outcome and rehospitalization after NICU discharge
     -  Cost outcomes, including the cost of acquiring MOM and DHM for NICU feedings and cost savings of MOM that are not generalizable to DHM
  2. Nutritional and bioactive differences between MOM and DHM that impact health and cost outcomes
      -  Maturity of the mammary gland (e.g., preterm versus term gestation)
      -  Stage of lactation (e.g., milk from early versus late lactation)
      -  Temperature change, including freeze-thaw cycles and pasteurization
      -  Handling, fortification and administration practices
  3. A common "human milk feeding" metric that combines MOM and DHM
      -  Examples of trends in research and quality improvement literature to combine these two     feeding types
      -  Limitations and examples of misleading conclusions with this approach
  4. Translating evidence about MOM, DHM and formula differences into routine NICU practice
      -  Use of standardized "talking points" to convey evidence 
      -  Does introduction of DHM feeding availability influence provision of MOM in the NICU?
      -  Key points for acquiring consent for the use of DHM in VLBW infants
  5. Summary, Conclusions, Questions

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