Donor human milk uses outside of the hospitalized preterm infant

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Sydney Alexandra McCune (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Maryanne Perrin

Abstract: Human milk (HM) is the gold standard for infant feeding. This is supported by extensive research which has shown benefits of HM in infants including reduced gastrointestinal infections, respiratory disease, and mortality. When the mother’s own milk (MOM) is unavailable, donor HM (DHM) is the recommended feeding option, especially for the preterm infant due to reduced risk of necrotizing enterocolitis. Despite a consensus of HM being the optimal nutrition for the newborn infant, there is a lack of consensus regarding analytical methods to study HM and clinical recommendations for using HM in high-risk populations. For example, it is unknown whether the terminal lactose in human milk oligosaccharides (HMOs) are impacting lactose measurement methods. Additionally, there is extensive research regarding HM feedings for hospitalized preterm infants, but little information on post-discharge feedings, including the frequency of DHM use and whether DHM needs the same safety standards as those used in the neonatal intensive care unit (NICU). Our research sought to explore emerging issues related to using DHM beyond the NICU. In aim 1, we determined if human milk oligosaccharides (HMOs) influence common assays for measuring lactose in HM. BioVision Enzymatic Assay and Miris Human Milk IR Analyzer were influenced by HMOs (p<0.05), while Megazyme Enzymatic Assay and Ultra-High Pressure Liquid Chromatography Mass Spectrometry were not. In aim 2, we measured the nutrient and bacterial composition of DHM that has been rejected by milk banks after pasteurization due to the presence of bacteria over 4 days of refrigerated storage. DHM with bacterial presence after pasteurization did not significantly change in bacteria, protein, lactose, or immunoglobulin A content over storage duration (p>0.05). In aim 3, we investigated post-NICU discharge preterm infant feeding regimens, infant feeding skills, and caregiver feeding perceptions and experiences in the first 4 weeks post-discharge. The number of infants receiving any human milk decreased from 70% at hospital discharge to 54% at 4 weeks post-discharge. Infant eating skills improved over time (p=0.096). Poor feeding behaviors were weakly correlated with poor caregiver experiences (r=0.319, p=0.105). Falling asleep during or soon after feeding was the most reported feeding behavior. Twenty-one percent of infants required nutritional intervention at their NICU follow-up visit. Any fortification at follow-up visit was moderately correlated with average weight gain since hospital discharge (r=0.491, p=0.033). In conclusion, this research showed that some methods for measuring lactose in HM are influenced by HMOs while others are not. Given that HMOs are non-digestible, this has implications for the energy values estimated for human milk. We also showed that DHM with limited bacterial presence post-pasteurization maintains its bacterial and nutrient content over 4 days of refrigerated storage, with 81% of the DHM samples containing less aerobic bacteria as compared to the infant formula. Based on these findings, this DHM with limited bacterial presence may be an option as a supplement for healthy term infants to remain on an exclusively human milk diet. There was no DHM use reported in our study of post-discharge feeding. Preterm infant feeding behaviors improve over the first four weeks at home and poor caregiver experiences were weakly associated with higher infant feeding behavior difficulty. Additionally, changes in feeding regimens are common in the first 4 weeks after hospital discharge. Finally, any fortification at follow-up visit was positively associated with average daily weight gain since hospital discharge.

Additional Information

Language: English
Date: 2023
Donor human milk, Human milk, Infant feeding, Nutrition, Preterm infant
Breast milk $x Analysis
Breast milk $x Composition
Premature infants $x Nutrition

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