P3A087: Disparities in Donor Human Milk Use at a High-volume Birthing Hospital

Background: Donor human milk (DHM) is an alternative to formula for supplementation of breastfed infants. It has been associated with increased exclusive breast milk feeding rates in the hospital, but can be costly. DHM utilization in hospitals has increased drastically, most recently with term newborns. There is scarce data on patient characteristics and volumes provided. Our hospital has a level IV NICU and ~10,000 deliveries per year. We began using DHM in our nursery in 2020 and saw an increase in utilization from 7% (n=618) in 2021 to 12% (n=1094) in 2022. Indications for DHM at our institution include a commitment to exclusive breast milk feeding, hypoglycemia, hyperbilirubinemia, weight loss greater than 10% of birth weight, separation from mother, contraindications to feeding of mother’s own EBM, and per provider discretion.

In preparation for a QI initiative to improve our DHM utilization, we aim to describe the patient population receiving DHM at our hospital and evaluate for any inequities across preferred language, race, ethnicity, and payer type as a substitute for socio-economic status.

Methods: A retrospective chart review was performed on all 2022 newborn nursery discharges. Newborns discharged from the NICU were excluded. Variables included sex, gestational age, birth weight, delivery type, diagnosis of hypoglycemia, volume of DHM, and length of stay. DHM utilization was compared across preferred language, race, ethnicity, and payor. Chi-square testing was used to compare differences in patient populations.

Results: A total of 9,419 newborn discharges from 2022 were reviewed. 1,100 (12%) newborns received DHM during their birth hospital stay. Newborns with a gestational age of less than 37 weeks, delivery by cesarean section, and hypoglycemia diagnosis were statistically more likely to have received donor human milk (p < 0.05). Birth mothers with English as the preferred language, non-public insurance, and who identify as white, Asian race or non-Hispanic ethnicity were statistically more likely to have received donor human milk (p < 0.05). A total of 8,577 oz of DHM was used in 2022 with a median of 4 oz/patient receiving DHM (std dev 48.8). With a cost of $5 per 1 oz, the estimated annual cost was $42,887.05. Exclusive breast milk feeding increased in the unit from 47% in 2020 to 62% in 2021 and 64% in 2022.

Conclusion: Evaluation of our hospital’s donor human milk utilization revealed significant inequities. It should be noted that the number of unavailable ethnicity and race limits those results. Next steps include improvements in accuracy of race and ethnicity data, a more streamlined education on DHM available in multiple languages, and evaluation of the impact of DHM volumes on future exclusive breastfeeding rates.