Effects of a Donor Human Milk Program on Maternal Breast Milk Rates

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Submission ID :
ESPR458
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Abstract: :

Background

In 2017 the AAP recommended the use of DHM for the VLBW population. That same year the Level 3 NICU at Staten Island University Hospital launched its DHM program for this high-risk population. As more NICUs begin utilizing DHM, it is unclear if this new practice has an effect on maternal pumping and exclusive maternal breast milk (EBM) rates in the NICU.

Objectives

Primary objective - compare the rates of EBM feeding among VLBW infants before and after the implementation of a DHM program in the Level 3 NICU at Staten Island University Hospital in 01/2017. Secondary objective - compare the rates of NEC pre‐ and post‐implementation of the DHM Program.

Methods

A retrospective chart review was conducted for newborns with GA ≤32 weeks and/or BW ≤1500 grams admitted to the NICU from 03/2014 to 06/2019. A 6 month "wash‐out" period occurred after the DHM Program began to allow for adequate staff education and culture change. Demographic data, neonatal morbidities, and nutritional information were obtained from the EMR. Type of enteral feeding was obtained on day of life (DOL) # 7, 28 and day of discharge. 

Results

The following chart details the demographics of the two cohorts:

* p-value < 0.05

Pre-DHM Program

Post-DHM Program

N

80

79

GA (weeks)

Mean ± SEM

29 ± 0.3

28 ± 0.3

BW (grams)

Mean ± SEM

1349 ± 53

1265 ± 51

Male

61%

57%

C/S

55%

66%

Singleton *

84%

70%


Demographics of the pre‐and post‐intervention cohorts were similar, with a smaller incidence of singletons noted post-intervention. To account for this confounder, only the multiple with the longest LOS was included in data analysis. Newborns who expired or were transferred to another institution before initiation of enteral feeds were also excluded.

Higher, but not statistically significant, use of EBM in the pre-intervention group on DOL 7 (74%) and 28 (66%) compared to the post-intervention group on DOL 7 (68%) and 28 (59%). At discharge, only 39% of mothers pre-intervention were providing EBM while 53% were in the post-intervention group, a statistically significant difference.

* p-value < 0.05

Pre-DHM Program

Post-DHM Program

Length of Stay (days)

40.7

46.2

Expired

13%

14%

NEC

4%

9%

There was a non-statistically significant increase in the incidence of NEC from pre‐ to post‐intervention. During the post‐intervention group, a NEC cluster occurred in a two month period significantly outside normal rates which appears to have skewed the data.

Conclusion

After initiating a DHM program, EBM rates declined by DOL 7 and 28 compared to when DHM was unavailable. This may be due to decreased maternal pressure to pump knowing that DHM is available to the infant if pumping is unsuccessful. This could also be due to a subconscious drop in emphasis on the importance of EBM or education by the NICU team. Further investigation of potential causes is ongoing, and emphasis of maternal education ensuring access to lactation and a breast pump is being prioritized. We are reassured by the noted increase in EBM usage at discharge.

Staten Island University Hospital - Northwell Health
Staten Island University Hospital Northwell Health

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