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.

Breastfeeding Reducing Childhood Obesity: Fact, Fiction or Sometimes?

Over the past 3 decades, an increasing number of studies and reviews have examined the relationship of breastfeeding and childhood obesity. The authors of Agency for Healthcare Research and Quality’s (AHRQ) Evidence Report on Breastfeeding meta-analysis concluded that children who were breastfed for at least 3 months were less likely to be obese than those never breastfed, taking into account multiple confounding factors.¹ The duration of breastfeeding was found to be inversely related to the risk of being overweight; each month of breastfeeding being associated with a 4% reduction in risk. A WHO meta-analysis from 2007 also concluded that longer breastfeeding (typically durations of 3 to 9 months), in comparison to no breastfeeding, was associated with lower rates of obesity.² The Framingham Offspring study noted a relationship of breastfeeding and a lower BMI in adults.³ A sibling difference model study showed that the breastfed siblings weighed 13 pounds less than formula fed siblings at a mean age of 14 and were less likely to reach BMI obesity threshold.⁴ Based upon these studies, the promotion of breastfeeding to prevent obesity has been recommended by the CDC, the Institute of Medicine, and the Surgeon General.

However, there are, however, other important studies that failed to find a relationship. The PROBIT study, the only randomized trial of breastfeeding in term infants, randomized an intervention to promote increased duration and exclusivity of breastfeeding in Belarus and found no significant differences in BMI, percent body fat, and obesity between the experimental and control group children at 11.5 years of age.⁵ The “discordant sibling study” looked at data obtained from the National Longitudinal Survey of Youth study and found that breastfeeding was not associated with significant improvements in childhood obesity when siblings who were fed differently during infancy, one breastfed, the other bottle fed, were compared.⁶

So how are we to interpret these conflicting studies? My opinion has been that, as the etiology of obesity is multifactorial, breastfeeding can play an important role in its prevention, but is unlikely to entirely prevent it. The limitation of most of these studies is that they look at breastfeeding alone. Future studies need to focus on the role of multiple modifiable factors on these conditions.⁷ 

ABM Advocates for Breastfeeding at the United Nations

ABM, as a worldwide organization dedicated to the promotion, protection and support of breastfeeding, has been involved in promoting breastfeeding at the UN for the past 10 years. ABM became a Non-Governmental Organization (NGO) in consultative status with the UN Economic and Social Council (ECOSOC) and is a member of the NGO Committee on UNICEF. As it is impossible to accomplish anything at the UN without collaboration, we partner with ILCA, WABA and CGBI as members of the “UN Breastfeeding Advocacy Team” known as “UNBAT”, to raise breastfeeding awareness at the UN and UNICEF.

This has been a busy year for advocacy. UNICEF drafted a Breastfeeding Advocacy Strategy in March which was improved with our input. We look forward to working with UNICEF in refining the advocacy strategy and developing an implementation plan over the next year. ABM representatives participated in events celebrating the 25th Anniversary of the Convention on the Rights of the Child which frames good health, including breastfeeding, as a fundamental right, in November in New York.

We are currently collaborating with our partners to include breastfeeding in the post-2015 Sustainable Development Goals (SDGs) which will be finalized by December, 2015 to replace the Millennium Development Goals which are expiring. Getting breastfeeding promotion into the post-2015 agenda is extremely important. We worked with our UNBAT partners and the Health NGO Group to request that breastfeeding be included as one of the “critical health-related issues to achieve sustainable development.”

ABM and its partners have applied to sponsor a “parallel event” at the annual Commission on the Status of Women in New York in March to raise the profile of breastfeeding as an important measure which improves the health of women and children.

We are encouraged by the increasing attention to breastfeeding at the UN and UNICEF and feel that there will be more opportunities to promote breastfeeding as part of the post-2015 Sustainable Development agenda, through the UNICEF Advocacy Strategy, during the CSW events and through ongoing collaboration with other health and nutrition groups. If any ABM members want to assist in this important work, please contact us.

Susan Vierczhalek, MD, FABM is ABM representative to the UN, Associate Professor of Clinical Pediatrics at New York University School of Medicine, medical Director of the Bellevue Hospital Newborn Service and Breastfeeding Program, Chair of the NY State Breastfeeding Coalition, Medical Director of the New York Milk Bank.

Larry Noble, MD, FABM, IBCLC is ABM representative to the UN with Susan, a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai in New York City and a Board member of ABM.