P3A089: Donor Human Milk Access and Utilization Within Well Newborn Nurseries Across Better Outcomes Through Research for Newborn (BORN) Network Sites in the United States

Background: The American Academy of Pediatrics recommends using donor human milk (DHM) for high-risk infants but recently expanded the recommendation for use in late preterm (34 to 36 6⁄7 weeks gestation) and early term (37 to 38 6⁄7 weeks gestation) infants if DHM is available. Baby Friendly hospitals are committed to providing mothers with breastfeeding support and have been positively correlated with DHM use. There are currently 28 milk banks (Human Milk Banking Association of North America) across the U.S. Given differences in regional availability, access to DHM, funding and insurance reimbursement, practice variation in the use of DHM for newborns is likely. The Academic Pediatric Association’s (APA) Better Outcomes through Research for Newborns (BORN) Network is a national collaborative of pediatric clinical researchers who evaluate well newborn care. Examination of DHM access and practices across BORN nurseries may allow for identifying possible disparities with use.

Methods: The objective of this study is to describe DHM access and practices among U.S. well newborn nurseries and identify potential disparities in DHM usage, using BORN nurseries as a representative sample. All BORN sites were invited to participate in a survey about DHM availability and utilization at their institution. Participants were surveyed regarding nursery location, criteria/policies in place for the use of DHM, and the type of DHM available. Preliminary data were analyzed with descriptive statistics.

Results: This survey has yielded 56 responses (43.4% response rate). Distribution of nurseries according to DHM use is shown in figure 1. Nursery and hospital characteristics are shown in Table 1. Of the respondents, 41.1% of nurseries are connected to local milk banks, but 83.9% of all nurseries reported access to DHM. Of those with access to DHM, 84.4% reported compliance with AAP recommendations for DHM use. Policies to guide DHM use were reported by 53.2% of nurseries. Most policies include a medical condition or birth weight criterion for DHM use (Table 1). Policies to guide the discontinuation of DHM use was reported by 38.3% of units. Term newborns are allowed DHM in 68.1% of nurseries. Of nurseries designated as Baby Friendly, 87.9% had access to DHM. Outpatient access to DHM was reported by 33.9% of all nurseries.

Conclusion: DHM access and use are not uniform across U.S. well newborn nurseries. Practice variation exists in eligibility for DHM use, with most nurseries reliant upon medical conditions and birth weight criteria. Nurseries with Baby Friendly distinction reported more DHM access. This survey demonstrates overall alignment with AAP recommendations for DHM use.