Introducing donor human milk to the NICU: lessons for Australia.
ABSTRACT There is an increased use of pasteurised donor human milk (PDHM) in North American neonatal intensive care units (NICU) in order to achieve exclusive human milk (EHM) feeding for preterm infants. Australia, on the other hand, is relatively new to reintroducing PDHM to NICUs. Very little is known about the perception of multidisciplinary NICU teams toward PDHM. This article reports on a survey of 89 NICU clinicians that was implemented during the first weeks of PDHM use in an American NICU, and was repeated 6 months later. Their knowledge and opinions of PDHM in addition to their inclination to recommend its use were evaluated using thematic coding and descriptive statistics. We found that after a 6-month trial, preparedness to recommend PDHM increased to 93%. We found that NICU clinicians' support for PDHM exceeded their knowledge about its risks and benefits and clinicians requested education about various aspects of PDHM. This research in this article aims to assist clinical staff educators as they go about introducing PDHM in NICUs.
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ABSTRACT: Numerous short and long-term benefits of breastfeeding the full-term infant have been acknowledged. The use of human milk in the neonatal intensive care unit (NICU) is emerging as the beneficial effects are being realized. Challenges facing the practitioners today include providing optimal storage and processing strategies for mother's own milk (MOM), as well as offering an alternative when MOM is unavailable or supply is insufficient. We review the health benefits of human milk for the ELBW infant and the strategies for optimal use of the milk in the NICU.Early human development 08/2013; DOI:10.1016/j.earlhumdev.2013.08.006 · 1.93 Impact Factor
Chapter: Breastmilk Donation as Care WorkEthnographies of Breastfeeding: Cultural Contexts and Confrontations, Edited by Tanya Cassidy and Abdullahi El-Tom, 12/2014: chapter Breastmilk Donation as Care Work; Bloomsbury., ISBN: 9781472569264
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ABSTRACT: Background: Use of donor human milk (DHM) is increasing, but criteria for its use are not well defined. Materials and Methods: We conducted a 34-question Internet-based survey of medical directors of U.S. level 3 and level 4 neonatal intensive care units (NICUs), with the goal of describing specifics of policies developed to guide DHM use in U.S. NICUs. Respondents reported NICU characteristics and details of policies concerning DHM use. Policy-specified criteria for DHM use, if any, were described. Bivariate and multivariate analyses were used to identify NICU characteristics associated with DHM use. Results: Respondents returned 153 (33%) surveys, with use of DHM reported by 91 (59%). Donor human milk use was more likely with more than 100 annual admissions <1500 g at birth (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.7) and with Vermont-Oxford Network participants (OR, 4.6; 95% CI, 1.8-11.6). Among 72 NICUs reporting a written policy, criteria for providing DHM required birth weights varying from <1000 to <1800 g and/or gestational ages from <28 to <34 completed weeks, but criteria were reportedly waived in many circumstances. Policies regarding duration of DHM therapy were similarly varied. Conclusions: Criteria for initiating and continuing DHM vary widely among U.S. level 3 and level 4 NICUs. Donor human milk use is more frequent in NICUs with many very low-birth-weight admissions and among Vermont-Oxford Network participants. Further research is needed to define short- and long-term outcomes and cost benefits of DHM use in subgroups of NICU patients, particularly for uses other than necrotizing enterocolitis prevention.Journal of Parenteral and Enteral Nutrition 09/2014; DOI:10.1177/0148607114550832 · 3.14 Impact Factor