A Decision Tree for Donor Human Milk: An Example Tool to Protect, Promote, and Support Breastfeeding.

Shelley Brandstetter,Nga Nguyen Quyhn,Alessandra Demarchis,Kiersten Israel-Ballard,Kimberly Mansen,Cyril Engmann

doi:10.3389/fped.2018.00324

Abstract

Despite decades of breastfeeding promotion, exclusive breastfeeding rates for the first 6 months of life remain low: around 40% globally. Infants that are admitted to a neonatal ward are even less likely to be exclusively breastfed. Lactogenesis is frequently delayed in mothers that deliver early, with the added burden of separation of the unstable newborn and mother. For such vulnerable infants, donor human milk is recommended by the World Health Organization, UNICEF, and professional organizations as the next best alternative when mother's own milk is unavailable and can serve as a bridge to full feeding with mother's own milk. Hospital support of optimal breastfeeding practices is essential with thoughtful integration of donor human milk policies for those infants that need it most. We propose a decision tree for neonatal wards that are considering the use of donor human milk to ensure donor human milk is used to replace formula, not to replace mothers' own milk. By first evaluating barriers to full feeding with mother's own milk, healthcare workers are encouraged to systematically consider the appropriateness of donor human milk. This tool also seeks to prevent overuse of donor human milk, which has the potential to undermine successful lactation development. In settings where donor human milk supplies are limited, prioritization of infants by medical status is also needed. Readily available and easy-to-use tools are needed to support healthcare staff and mothers in order to improve lactation development and neonatal nutrition.

Highlights

Breastfeeding is well known as the optimal source of nutrition for infants, and is recommended as the sole food until 6 months of age [1,2,3]
In order to support breastfeeding, ensure optimal nutrition for all infants, and prevent misuse, a decision tree was requested by clinicians and experts in human milk banking and neonatal care
donor human milk (DHM) can provide the neonate with a more optimal source of nutrition than formula, while the mother builds up her breast milk supply through alternative methods of expression

Summary

A Decision Tree for Donor Human Milk

Shelley Brandstetter 1,2,3,4*, Kimberly Mansen 2,4, Alessandra DeMarchis 2, Nga Nguyen Quyhn 5, Cyril Engmann 2,3,4,6 and Kiersten Israel-Ballard 2,3. Lactogenesis is frequently delayed in mothers that deliver early, with the added burden of separation of the unstable newborn and mother For such vulnerable infants, donor human milk is recommended by the World Health Organization, UNICEF, and professional organizations as the best alternative when mother’s own milk is unavailable and can serve as a bridge to full feeding with mother’s own milk. By first evaluating barriers to full feeding with mother’s own milk, healthcare workers are encouraged to systematically consider the appropriateness of donor human milk. This tool seeks to prevent overuse of donor human milk, which has the potential to undermine successful lactation development. Available and easy-to-use tools are needed to support healthcare staff and mothers in order to improve lactation development and neonatal nutrition

INTRODUCTION

BACKGROUND

CONCLUSION