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Presence of human milk bank is associated with elevated rate of exclusive breastfeeding in VLBW infants

Authors:
  • Associazione Italiana delle Banche del Latte Umano Donato (AIBLUD)

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Abstract Human milk confers health benefits of vital importance for the sick and preterm infants in neonatal intensive care units (NICUs). Mother's own milk is the first choice in preterm infant feeding, and every effort should be made to promote lactation. When mother's milk is not available or is insufficient, donor human milk (DHM) is recommended. Yet, occasionally, the concern that the use of DHM might decrease breastfeeding is being raised. The present data collection planned by the Italian Association of Human Milk Banks (AIBLUD) in collaboration with the Italian Neonatal Network (INN) attempted to address this concern. A total of 4277 very low birth weight (VLBW) infants from 83 Italian NICUs were evaluated for this comparative analysis. The 83 Italian NICUs were divided into two groups: centers with a human milk bank (HMB) and centers without a HMB; the available parameters in the network - "any and exclusive breastfeeding rates" and "exclusive formula rate" at discharge - were compared. Exclusive breastfeeding rate at discharge was significantly higher in NICUs with a HMB than in NICUs without (29.6% vs. 16.0%, respectively). Any breastfeeding rate at discharge tended to be higher in the NICUs with HMB (60.4% vs. 52.8%, P=0.09), and exclusive formula rate was lower in the NICUs with HMB (26.5% vs. 31.3%), but this difference was not significant. This report shows that the presence of a HMB and the use of DHM in NICU are associated with increased breastfeeding rate at discharge from the hospital for VLBW infants.
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DOI 10.1515/jpm-2012-0196J. Perinat. Med. 2013; 41(2): 129–131
Recommendation and Guidelines for Perinatal Practice
Sertac Arslanoglu a , Guido E. Moro a,*
, Roberto Bell ù , Daniela Turoli , Giuseppe De Nisi , Paola
Tonetto and Enrico Bertino
Presence of human milk bank is associated with
elevated rate of exclusive breastfeeding in VLBW
infants
Abstract: Human milk confers health benefits of vital
importance for the sick and preterm infants in neonatal
intensive care units (NICUs). Mother s own milk is the first
choice in preterm infant feeding, and every effort should
be made to promote lactation. When mother s milk is not
available or is insufficient, donor human milk (DHM) is
recommended. Yet, occasionally, the concern that the use
of DHM might decrease breastfeeding is being raised. The
present data collection planned by the Italian Associa-
tion of Human Milk Banks (AIBLUD) in collaboration with
the Italian Neonatal Network (INN) attempted to address
this concern. A total of 4277 very low birth weight (VLBW)
infants from 83 Italian NICUs were evaluated for this com-
parative analysis. The 83 Italian NICUs were divided into
two groups: centers with a human milk bank (HMB) and
centers without a HMB; the available parameters in the
network “ any and exclusive breastfeeding rates ” and
exclusive formula rate at discharge were compared.
Exclusive breastfeeding rate at discharge was significantly
higher in NICUs with a HMB than in NICUs without (29.6 %
vs. 16.0 % , respectively). Any breastfeeding rate at dis-
charge tended to be higher in the NICUs with HMB (60.4 %
vs. 52.8 % , P = 0.09), and exclusive formula rate was lower
in the NICUs with HMB (26.5 % vs. 31.3 % ), but this differ-
ence was not significant. This report shows that the pres-
ence of a HMB and the use of DHM in NICU are associated
with increased breastfeeding rate at discharge from the
hospital for VLBW infants.
Keywords: Donor human milk; breastfeeding; lactation;
milk bank; preterm infant.
a World Association of Perinatal Medicine (WAPM), Working Group
on Nutrition.
*Corresponding author: Guido E. Moro, MD, Italian Association of
Human Milk Banks (AIBLUD)c/o Biomedia, Via Libero Temolo No 4,
20126, Milan, Italy, Tel.: + 39 3485659614,
E-mail: guidoemoro@tiscali.it
Sertac Arslanoglu: Italian Association of Human Milk Banks , Milan ,
Italy
Roberto Bell ù : Italian Neonatal Network (INN) , Lecco , Italy ; and
NICU , Manzoni Hospital, Lecco , Italy
Daniela Turoli: Italian Neonatal Network (INN) , Lecco , Italy
Giuseppe De Nisi: Italian Association of Human Milk Banks , Milan ,
Italy
Paola Tonetto: Italian Association of Human Milk Banks , Milan ,
Italy ; and NICU , University of Turin, Turin , Italy
Enrico Bertino: Italian Association of Human Milk Banks , Milan ,
Italy ; and NICU , University of Turin, Turin , Italy
Recent research and systematic reviews have reinforced
the conclusion that breastfeeding and human milk (HM)
confer health benefits for the infant and the mother, and
represent the reference normative standards for infant
feeding and nutrition [1] . These benefits are of vital impor-
tance particularly for sick and preterm infants in neona-
tal intensive care units (NICUs). Feeding preterm infants
HM decreases the rate of infection, necrotizing entero-
colitis (NEC), and mortality, while improving neurocog-
nitive and cardiovascular outcomes in the long-term [2] .
Mother s own milk (MOM) is the first choice in preterm
infant feeding. When mother s milk is not available or is
insufficient, donor human milk (DHM) is recommended
[1, 2] and has been considered as one of the supportive
measures for the establishment of breastfeeding by some
authors who applied Baby-Friendly Hospital Initiatives to
NICUs [3, 4, 6] .
Yet, occasionally, a concern is being raised in the
health community: Does the presence of a human milk
bank (HMB) and the use of DHM attenuate the efforts to
promote lactation resulting in decreased breastfeeding
rates in preterm infants ? The present data collection has
been planned by the Italian Association of Human Milk
Banks (AIBLUD) in an attempt to address this concern.
The data have been provided by the Italian Neonatal
Network (INN) which is integrated to the well-known
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130Arslanoglu et al., Association between human milk bank and exclusive breastfeeding
Vermont Oxford Network (VON). A total of 4277 very low
birth weight (VLBW) infants admitted to the 83 Italian
NICUs registered in the INN-VON program (from a total of
98 NICUs in the country) in the year 2010 were evaluated
for this comparative analysis. The available parameters
related to breastfeeding at the INN-VON database were
as follows: rate of exclusive breastfeeding at discharge,
“ any breastfeeding at discharge, ” and “ exclusive formula
at discharge. Italian NICUs were divided into two groups:
centers with a HMB and centers without a HMB. The dis-
tribution of the NICUs with and without HMB was similar
to that of the population in the three main geographi-
cal areas of Italy: north, center, and south. In fact, the
northern part of Italy in the year 2010 had a population of
28 million people, whereas the central and southern parts
combined reached a population size of 31 million people
[data from THE Italian National Institute of Statistics
(ISTAT), 2010] (Table 1
).
The newborns admitted to the two groups of NICUs
were similar in birth weight, gestational age at birth, and
proportion of singletons or multiples (Table 2 ). Feeding
data of the two groups at discharge from the hospital were
compared by using the Mann-Whitney test. Statistical sig-
nificance was set at the 5 level of probability. Statistical
analyses were performed using the SPSS 17.0 software for
Windows (SPSS, Inc., Chicago, IL, USA).
The NICUs with and without HMB were comparable
in terms of NICU characteristics and size. Feeding data
at discharge are presented in Table 3 and clearly show
North Center South Total
With HMB (. % ) (. % ) (. % ) 
Without HMB  (. % )  (. % )  (. % ) 
Table 1 Geographical distribution of the 83 Italian NICU.
Median birth
weight (g)
Birth weight
range (g)
Gestational
age (weeks)
Gestational age
range (weeks)
Number of
singletons
Number of
multiples
Total number
of infants
With HMB   –    –   ( % )  ( % ) 
Without HMB   –    –   ( % )  ( % ) 
Table 2 Birth weight, gestational age, and proportion of singletons or multiples in the infants admitted to the 83 NICUs.
Italian NICUs without
a HMB (n = )
Range ( % ) Italian NICUs with
a HMB (n = )
Range ( % ) P-value
Any breastfeeding ( % ) . . – . . . – . .
Exclusive breastfeeding ( % ) . . – . .  – . .
Exclusive formula ( % ) . . – . .  – . .
Table 3 Feeding data for VLBW infants at discharge from the hospital.
that the presence of a HMB in a NICU is associated with
increased breastfeeding rate at discharge from the hospi-
tal for VLBW infancts. This positive impact is more pro-
nounced for exclusive breastfeeding.
Our results represent the first national survey on the
positive effects of the availability of DHM on breastfeed-
ing rate of VLBW infants at discharge, confirming the
existing data from Australia [7] , USA [5] , and Spain [8]
which already indicate that the presence of a HMB does
not decrease the breastfeeding rate of VLBW infants, but
is supportive for breastfeeding promotion. The report
from Australia indicates that the opening of a HMB
did not reduce the rate of breastfeeding, but increased
the breastfeeding rate at discharge [7] . In Utah, USA, a
program designed to improve HM availability for preterm
infants and consisting of using exclusively HM (MOM and/
or DHM) was implemented in a NICU: the BEST program
( Breast Milk Early Saves Trouble ). Its implementation
for 12 months increased HM and DHM use in NICU, and
breastfeeding rate at discharge tended to increase com-
pared to the situation prior to the implementation period
[5] . The Spanish study from Madrid evaluated the impact
of the establishment of a HMB in a NICU on the rate of
exclusive breastfeeding at discharge and formula use in
NICUs. The researchers concluded that the presence of a
HMB in a neonatal unit did not reduce the rate of exclu-
sive breastfeeding at discharge, but did reduce the use
of infant formula during the first 4 weeks of life. Also,
having DHM available enabled earlier initiation of enteral
feeding [8] .
Our study shows a great variability in breastfeeding
rate among NICUs; this observation demonstrates the
need to further improve uniform breastfeeding promo-
tion and support in Italian NICUs. Our confirmative data
pointing at a positive impact of DHM use on breastfeeding
rate suggest that human milk banking is not only about
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Arslanoglu et al., Association between human milk bank and exclusive breastfeeding131
collecting, storing, processing, testing, and distributing
milk, but also about the extension of the culture of breast-
feeding and use of HM in NICUs, and may serve also as a
tool for promotion of lactation. Besides, having access to
DHM when MOM is insufficient might attenuate the pos-
sible feeling of guilt and inadequacy among mothers and
might be encouraging.
We acknowledge that the promotion of breastfeeding
and the use of MOM come first in NICUs. Regular maternal
support to establish and maintain lactation and transition
to breastfeeding has the highest priority. The purpose of
HM banking is to provide HM supply for infants (mainly
preterm). When MOM is not available or is insufficient,
donor milk is the best alternative and is associated with
elevated rate of exclusive breastfeeding.
Received August 17, 2012. Accepted October 16, 2012. Previously
published online November 15, 2012.
References
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[3] do Nascimento MB, Issler H. Breastfeeding the premature
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[4] Maastrup R, Bojesen SN, Kronborg H, Hallstrom I. Breastfeeding
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[5] Montgomery D, Schmutz N, Baer VL, Rogerson R, Wheeler R,
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[6] Nyqvist KH, Kylberg E. Application of the Baby Friendly Hospital
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The authors stated that there are no conflicts of interest regarding
the publication of this article.
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... Natural mother's breast milk (MBM) is the best of all feeding options for all newborns especially the preterm (1)(2)(3)(4)(5)(6). However, natural MBM is not always available, can be insufficient to provide an adequate amount (soon after delivery, maternal refusal or death) or is contraindicated (maternal illness, use of illicit drugs or medications, or un-satisfactory collection practices). ...
... However, natural MBM is not always available, can be insufficient to provide an adequate amount (soon after delivery, maternal refusal or death) or is contraindicated (maternal illness, use of illicit drugs or medications, or un-satisfactory collection practices). Under these circumstances pasteurized donor breast milk (PDBM) is considered the second-best option as compared to the formulas derived from cow's milk [1][2][3][4][5][6][7]. Therefore, PDBM is commonly used in Neonatal Intensive Care Units (NICUs) worldwide. ...
... The overarching goal is to reach full enteral EBM feeding in the shortest possible time [25][26][27][28][29][30][31][32][33][34][35][36][37][38]. However, when mother's EBM milk is not available, insufficient or not suitable, supplementation with PDBM or specially designed preterm formulas is a common practice [1][2][3][4][5][6]. PDBM is considered to be a better option than the preterm formula [1][2][3][4][5][6]. ...
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Natural mother's breast milk (MBM) is the best food for all newborns especially the preterm. However, when natural MBM is not available or insufficient donor breast milk (DBM) is the second-best option. Sterifeed or HSC human milk pasteurizers have been commonly used for several decades. While these devices have served the purpose, they are relatively large, expensive, require special electrical and water connections, need a large amount of water which is not recycled and an ongoing supply of disposable plastic bottles. In addition, the use of these machines requires special training. Here we describe the development of a compact, automated; user-friendly human breast milk pasteurizer (HBMP) named Kimie capable of pasteurizing small volumes of DBM. This device does not require special water plumbing, recycles water, is inexpensive and does not require FDA approval.
... g Data were unavailable for cases that did not attain full enteral feeding. Vázquez et al., 2019) or even increase the breastfeeding rate (Arslanoglu et al., 2013;Bertino, 2013). This could be attributed to the promotion of breastfeeding education after the establishment of a human milk bank (Arslanoglu et al., 2013). ...
... Vázquez et al., 2019) or even increase the breastfeeding rate (Arslanoglu et al., 2013;Bertino, 2013). This could be attributed to the promotion of breastfeeding education after the establishment of a human milk bank (Arslanoglu et al., 2013). ...
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Compare with preterm formula, donor human milk (DM) is associated with a lower risk of mortality and morbidity in preterm infants. It is thus deemed superior to preterm formula as the sole diet or supplement to own mother's milk (OMM) for preterm infants, especially for those with very low birthweight (VLBW). This historic cohort study investigated the relationship between DM availability, and enteral feeding, body growth of VLBW infants by comparing two cohorts before and after the establishment of a human milk bank. A sub-analysis was also conducted between small-for-gestational-age (SGA) and non-SGA infants in our cohorts. Our results showed that DM availability was associated with earlier initiation and faster advancement of enteral feeding, earlier attainment of full enteral feeding, and a higher proportion of OMM in enteral feeding. DM availability was also associated with earlier regain of birthweight, but not with better body growth. SGA and non-SGA infants responded differently to DM availability with only the non-SGA group showing improved enteral feeding associated with DM availability. The poor growth of VLBW infants with fortified DM warrants further investigations on better fortification strategies to further improve body growth. Studies are also needed on long-term effects of DM feeding on the development of VLBW infants.
... Mother's breast milk (MBM) is the Rolls Royce of all feeding option for all neonates [1][2][3][4][5][6]. However, MBM is not always available, insufficient or is not suitable. ...
... However, MBM is not always available, insufficient or is not suitable. Under these conditions, pasteurized donor breast milk (PDBM) purchased from a donor breast milk bank (DBMB) is a better option than the preterm formula [1][2][3][4][5][6]. DBMB rely on mothers who have delivered a baby at full-term gestation and have been lactating for several weeks [7][8][9][10]. ...
... Arslanoglu et al evaluated a total number of 4277 very low birth weight infants in 83 Italian NICUs and found monopolized breastfeeding rate at discharge was significantly greater in NICUs with a human milk bank (HMB) than in NICUs without it (29.6% vs. 16.0 %, respectively). 22 The rate of NEC was significantly different between the study groups and showed a significant decrease in the post-launch group (P = 0.035). A study by Quitadamo et al also confirmed the protective impact of nutrition with mother's or DM against NEC in low-birth weight infants. ...
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Background: The WHO and UNICEF have suggested pasteurized donor milk (PDM) as the best alternative for infants who do not receive enough milk from their mothers. Objective: This study aimed to assess the short-term outcomes of launching the first mother's milk bank in North-West of Iran. Methods: The present retrospective study included 366 premature infants (181 pre-launch and 185 post-launch) who were hospitalized in Al-Zahra Hospital of Tabriz, Iran. The study included infants with birth weight ˂2000 g and/or gestation age ˂32 weeks who were born before and after the launch of mother's milk bank. Frequency of necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), late onset sepsis (LOS) and mortality rate were compared. Data were analyzed using SPSS 23 with the chi-square test, Fisher exact test, independent t test, and logistic regression test. Results: In total, NEC grade ≥2 was reported in 9 cases; 8 cases (4.41%) in pre-launch and one case (0.54%) in post-launch (adjusted OR=0.091; 95% CI=0.010 to 0.849, P=0.035). ROP was reported in 21 cases in two groups. Nineteen cases (10.5%) belonged to the pre-launch group and 2 cases (3.7%) to the post-launch group (adjusted OR=0.105; 95% CI=0.022 to 0.488, P=0.004). LOS was also found in 17 cases (9.39%) in the pre-launch group and 4 cases (2.16%) in the post-launch period, suggesting a significant difference between the two groups (adjusted OR=0.297; 95%CI=0.089 to 0.995, P=0.049). There was no significant difference in mortality of infants during hospitalization between the two groups (P=0.789); however, it was decreased from 15 to 8. Conclusion: Launching the human milk bank significantly improved the outcomes of premature infants.
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... Our data show that the use of human milk during the length of hospital stay resulted in EBF at discharge. When supplements are required or desired, human milk provided by the mother [29] or by an HMB [30] offers several benefits to hospitalized high-risk newborns [2,21,[31][32][33]. There are well-documented general and systemic benefits [1] as well as specific benefits of human milk for high-risk newborns, such as protection from necrotizing enterocolitis, retinopathy of prematurity, and bronchopulmonary dysplasia, among others [33][34][35]. ...
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Breastfeeding and the use of human milk
American Academy of Pediatrics. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827 -41.