Evaluation of a donor human milk program for very low birth weight infants

Background: Mothers of VLBW (very low birth weight) infants are less likely to initiate milk expression and more likely to discontinue milk expression earlier than mothers of term infants. Use of Donor Human Milk (DHM) in the neonatal intensive care unit(NICU) setting has allowed VLBW infants to receive the benefits of human milk when their mothers are unable to provide either some or all the milk they need. An increasing number of NICUs across the United States offer DHM as a supplement to make human milk standard of care for the VLBW population. Formal evaluation of these programs is warranted. Methods: In August, 2010, DHM became standard of care for all VLBW infants <32 weeks or <1800 grams for 10 weeks or until the infants reaches 50% full oral feedings. To compare the pre/post DHM periods, prospective clinical data were collected for all VLBW infants hospitalized >28 days. Primary outcomes included differences in necrotizing enterocolitis rates, total enteral intake and number of total perenteral nutrition (TPN)days. Results:Relative to the pre-DHM period, fewer TPN days (mean=9;p=0.01), decreased use of formula and increased intake of human milk were observed. In multivariable mixed modeling, DMH recipients and non-recipients did not differ in weight gain. Of the annual $36,000 DHM budget, $25,000 and $17,728 were spent each year. Conclusion: Adopting an all human milk diet for VLBW infants as standard of care improves clinical outcomes by decreasing TPN days and decreasing formula use with no differences in weight gain. Cost was not prohibitive.