P2C270: Assessment of Donor Human Milk Access and Utilization Within Neonatal Intensive Care Units Across the United States

Background: The American Academy of Pediatrics recommends use of donor human milk (DHM) for high-risk infants (birth weight less than 1500 grams and those with intestinal diseases) but has expanded the recommendation for use in late preterm and early term infants, if DHM is available. 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, there are likely practice variations in the use of DHM. Examination of DHM access and practices across neonatal intensive care units (NICU) may allow for identifying possible disparities in its use.

Methods: The objective of this study is to describe DHM access and practices among U.S. NICUs and identify potential disparities in DHM usage. Medical directors of NICUs were identified through the Section on Neonatal Perinatal Medicine distribution list and electronically polled. Participants were surveyed regarding unit location, criteria/policies in place for the use of DHM, and the type of DHM available.

Results: This survey yielded 137 unique responses. Distribution of NICUs according to DHM use is shown in figure 1. Unit and hospital characteristics are shown in Table 1. Of the respondents, 97.1% indicated access to DHM and its use within the NICU. Of units with access to DHM, 91.7% reported familiarity and compliance with AAP recommendations for DHM use. Formal policies to guide DHM use were reported in 93.2% of units. Most policies include a gestational age, birth weight and/or medical condition criterion for use (Table 1). Of these units, 81.2% of units have a policy to guide discontinuation of DHM; the majority of these policies contain a corrected gestational age criterion. Healthy term newborns are granted access to DHM in 49.6% of units. Within 79.7% of units, parental/guardian consent is required for use of DHM. Funding for DHM is covered by hospital budget in 80.5% of units. While 20.3% fund by insurance reimbursement, 3.8% were by grants; 16.5% was uncertain of coverage of DHM costs.

Conclusion: DHM access and use is common across U.S. NICUs. Although there are commonalities in criteria for provision of DHM, eligibility criteria are variable. Similar findings exist amongst policies used for the discontinuation of DHM. From this sampling, there may be regional and pay variation, but further research is needed to evaluate potential disparities in U.S. NICUs.