For a critically ill infant, a completely human-based milk diet offers tremendous health benefits. That is why breast milk is highly encouraged by neonatologists treating premature babies. But physicians understand breastfeeding in the NICU may have additional challenges. The American Academy of Pediatrics (AAP) agrees, releasing an updated policy statement this year speaking to the use and safety of donor milk in NICUs.
Both clinical studies and neonatologists such as Barbara Carr, MD, support the use of donor milk in NICUs, particularly for infants who are low birth weight or at risk for intestinal issues. Medically speaking, human breast milk is complete nutrition, said Dr. Carr, a MEDNAX-affiliated neonatologist in Kansas City. It provides all of the dietary elements and immune support that a growing term baby needs. “It is especially important in the NICU for babies who missed out on third trimester immune protection,’” said Dr. Carr. Human milk use decreases feeding intolerance in babies and reduces the length of time in the NICU. It also decreases the likelihood of developing a potentially serious gastrointestinal disease called necrotizing enterocolitis, which can cause death. Dr. Carr has witnessed all of these breast milk benefits at her facility as well.
Physicians such as Carr know that “breast is best,” but it is more than that. As the 2012 AAP statement on breastfeeding reiterates, feeding only breast milk to an infant for at least the first four to six months of life has the effect of decreasing illness:
These statistics cited by the AAP are ones Dr. Carr shares often with patients, especially when explaining the value of breast milk in the NICU. The 2017 AAP policy now speaks to the safety and value of donor milk in NICUs, which further supports Carr’s position. “We’ve been believers for a long time,” she said. “Donor milk is a safe product. There is no reason not to be using it, even from a cost perspective.”
By “we,” Dr. Carr means her team at Saint Luke’s Hospital. Carr serves as Medical Director for Saint Luke's Health System NICUs. She is also Medical Director for the Heart of America Mothers' Milk Bank, which began in 2012.
Donor milk is not a new concept, even in NICUs. The Human Milk Banking Association of North America (HMBANA), the non-profit professional association for donor human milk banking, began in 1985 and has set the standards and guidance for human milk donation. Carr was instrumental in developing the Heart of America Mothers' Milk Bank at Saint Luke's Hospital, which services Kansas City and surrounding areas.
At Saint Luke’s NICU, parents with premature children who require feeding support are fully educated on the use of human milk. “Clinically, nothing is better than mom’s own milk,” said Carr. But sometimes that is not an option. A mother’s supply may be affected by medications she is taking, by illness or by difficulties meeting her baby’s needs, especially in the case of multiples. If donor milk is used, “we use it as a bridge and/or supplement to mother’s own milk,” said Carr.
Sometimes, a lack of understanding about the value of human milk and donor breast milk is the challenge Dr. Carr and her team must overcome. When talking with families about the choice of what to feed their babies, the Saint Luke’s NICU team fully explains the benefits of donor milk and the concerns with formula. They then require the family to sign consent for one of the two options. The consent process is meant to draw attention to the potential risk of formula use as well as educate a family about the importance of donor milk and preferably providing mother’s own milk. “Once educated, it is rare that a mother does refuse donor milk, but once she is handed a consent form for formula, she often reexamines the decision,” said Dr. Carr. "Our goal is to feed a baby in the healthiest way that we can.”
Barbara Carr, MD, earned her medical degree at the University of Missouri-Columbia. She completed her pediatric residency at The Children’s Mercy Hospital in Kansas City and her neonatology fellowship at the James Whitcomb Riley Hospital for Children in Indianapolis. She is a fellow of the American Academy of Pediatrics and a member of the AAP Section on Perinatal Pediatrics. Dr. Carr is board certified in neonatal-perinatal medicine.