Survey of Enteral Feeding of Preterm Infants and the Human Milk Bank in Japan.

Abstract

In Japan, the first human milk bank (HMB) was established in 2017, which changed the practice of enteral feeding in neonatal care. This study investigated the practice of enteral feeding of preterm infants after the establishment of the HMB in Japan and examine future issues. A survey was conducted in 251 neonatal intensive care units (NICUs) from December 2020 to February 2021. The response rate was 61%. Although approximately 59% and 62% NICUs responded for ELBWI and VLBWI, only 30% and 46% could achieve this, respectively. Artificial nutrition was used to initiate enteral feeding for ELBWI in 24% and VLBWI in 56% of NICUs. Of the NICUs, 92% considered HMBs necessary or rather necessary and 55% wanted to use the HMB but could not. The major reasons for the same were (1) paying the annual membership fee of the HMB is troublesome, (2) obtaining approval from the facility is difficult, and (3) using the HMB is complicated. The indication and discontinuation for using donor milk vary among NICUs. Only in 17%, milk expression started within 1h delivery. Compared with before the establishment of the HMB, more NICUs are currently willing to start enteral feeding for preterm infants earlier. However, the implementation of enteral feeding appears to be challenging. Issues related to the HMB highlighted by the responses need to be addressed. Additionally, guidelines for using donor milk need to be established.