Many U.S. hospitals did not have human donor milk available for infants with very low birth weight (VLBW) who were not receiving enough mother’s milk, according to a CDC report.
Among hospitals with level III and IV neonatal care units, 13.0% reported that they did not have human donor milk available for infants with VLBW, stated Ellen Boundy, ScD, of the CDC National Center for Chronic Disease Prevention and Health Promotion in Atlanta, and colleagues.
Only 54.7% of hospitals reported that donor milk was received by at least 80% of infants with VLBW, they said in the Morbidity and Mortality Weekly Report.
By hospital type, donor milk was reported as being unavailable for infants with VLBW at:
- 11.6% of non-profit hospitals
- 16.0% of for-profit hospitals
- 17.1% of government or military hospitals
- 12.4% of teaching hospitals
- 11.1% of hospitals with a Baby-Friendly designation
- 14.3% of those without the non-Baby-Friendly designation
For infants above the VLBW threshold (≥1,500 g) at level II, III, or IV units, 40.1% of hospitals did not have donor milk available, the authors reported.
About 50,000 infants are born each year with VLBW in the U.S., they noted, and in these cases, human milk has been shown to decrease the risk of necrotizing enterocolitis. It also reduces the risk of late-onset sepsis, chronic lung disease, retinopathy of prematurity, and neurodevelopment impairment, they said.
When a mother’s own milk is insufficient or unavailable, supplemental donor milk is necessary, but “limitations in the availability and use of donor milk for infants with VLBW might be due to a variety of factors,” the researchers said. “Most hospitals access donor milk from banks accredited by the nonprofit Human Milk Banking Association of North America, with 28 member milk banks currently operating in 25 states.”
Donor milk availability at hospitals can be “affected by supply from milk banks, cost, and reimbursement, which can vary by state and payment source,” they stated. “Milk bank supply is in turn affected by barriers persons might face when considering milk donation, such as lack of knowledge about milk banking and beliefs about acceptability of donation. Hospital leadership support and logistical challenges to implementing donor milk programs might also play a role in donor milk availability.”
Boundy’s group emphasized that addressing these barriers to providing human donor milk could help reduce morbidity and mortality among infants with VLBW, and lower the risk of other potential health complications. For instance, one study showed that children were 23% less likely to be diagnosed with respiratory allergies by age 6 years if they had been exclusively fed human milk for the first 3 months of life; in another study, an exclusive diet of human milk in that period was associated with a reduced risk of school-age asthma.
The current study was conducted through the Maternity Practices in Infant Nutrition and Care (mPINC) survey, which is a biennial census survey of all U.S. maternity care hospitals, to monitor practices and policies related to infant feeding and nutrition. The prevalence of donor milk was examined by unit level and by infant weight.
In 2020, a total of 2,103 hospitals participated in mPINC, 616 of which had level III or IV infant care units. Data on infants with VLBW were restricted to hospitals with level III or IV units, where infants with VLBW typically receive care.
Donor milk use among infants with VLBW was examined by hospital type, teaching hospital status, Baby-Friendly designation, number of annual births, region, and state.
The authors noted that the percentage of infants with VLBW that required donor milk was not well documented. In addition, there was the potential for social desirability bias because hospitals’ use of donor milk is self-reported. Finally, the mPINC does not collect data from neonatal units that don’t provide maternity care, such as children’s hospitals.
Boundy and co-authors disclosed no relationships with industry.