AAP New Policy Statement on Donor Human Milk for the High Risk Infant
While the birth of neonatology was in the late 1800s with the development of the incubator, it was only in the 1970’s when the modern NICU was established with the neonatal respirator. More advanced respirators and other technologic developments, including important medications such as surfactant and nitric oxide, have dramatically improved the outcome of preterm infants. Yet, one of the most important “new developments” to improve the care of these infants, is feeding an exclusive human milk diet. It is now clear that exclusive breastmilk decreases preterm mortality and the incidence of necrotizing enterocolitis, sepsis, BPD and ROP, while increasing infant brain volume and neurodevelopment in infancy, childhood and adolescence.
Therefore, it is noteworthy that three AAP committees, the Committee on Nutrition, the Section on Breastfeeding and the Committee on Fetus and Newborn, the committee that writes policies for neonatologists, combined to write a policy statement supporting the use of pasteurized donor human milk in high risk preterm infants, with priority for those less than 1500 grams, when mother’s milk is not available. It states that the use of donor human milk in preterm infants is consistent with good health care. It recognizes that the use of donor milk is limited by its availability and affordability. It asserts boldly that the use of donor human milk should not be limited by an individual’s ability to pay. It urges health care providers to advocate for policies that assure reimbursement for its cost, while expanding the growth of milk banks by improving governmental and private financial support.
The policy states that donor milk for these high risk infants be obtained only from HMBANA and commercial milk banks that identify and screen donors, pasteurize milk and culture the post-pasteurization milk according to quality-control guidelines. It discourages families from direct human milk sharing or purchasing from the internet due to the increased risks of infections and the potential exposure to contamination with medications, drugs or other substances. It recognizes, however, that current pasteurization methods destroy many bioactive components of donor milk and encourages the development of alternative sterilization methods that better preserve these factors.
The statement states that the optimal feeding choice for preterm infants is mother’s own milk. Donor milk should be used when mother’s milk is unavailable or as a bridge or support while the mother’s milk is made available. It urges health professionals to encourage and assist mothers to pump or express milk and to provide their own milk whenever possible. But it also encourages providers to discuss with these families the high level of safety of milk obtained from milk banks and the tremendous benefits of human milk.
We can now envision a future where the overwhelming majority of high risk preterm infants will receive the low-tech, but very powerful, intervention of an exclusive diet of mother’s and/or donor milk.
Donor Human Milk for the High-Risk Infant: Preparation, Safety and Usage Options in the U.S. This AAP policy will be published in the January issue of Pediatrics.
Larry Noble MD, FABM, IBCLC is a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai and Elmhurst Hospital in New York City, the Secretary of ABM and Policy Chair of the AAP Section on Breastfeeding. He declares a hugh conflict of interest as one of the Lead Authors on this Policy Statement. You can follow him on Twitter @GalactoDoc
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