482 - Donor Human Milk Practices within U.S. Neonatal Intensive Care Units

Poster Number: 482
Publication Number: 482.1795

Background: The American Academy of Pediatrics (AAP) 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 only 29 milk banks across the U.S. Given differences in regional availability, access to DHM, funding/insurance reimbursement, there are likely variations in the use of DHM. Examination of DHM access and practices across neonatal intensive care units (NICU) may allow for identifying disparities in its use.

Objective: Describe DHM access and practices among U.S. NICUs and identify potential disparities in DHM use.

Design/Methods: 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 on the use of DHM, and the type of DHM available.

Results: This survey yielded 139 unique responses. Unit and hospital characteristics are shown in Table 1. Of the respondents, 97.1% indicated access to DHM and its use (Figure 1). Of units with access to DHM, 92.7% reported familiarity and compliance with AAP recommendations for DHM use. Formal policies to guide DHM use were reported in 93.3% of units; however, there was wide variation in the criteria within these policies. Most policies include a gestational age with more variation on the inclusion of birth weight and/or medical condition criterion (Table 2). Fewer (20.7%) units allow use of DHM in any admitted infant with most allowing its use as a bridge until maternal milk supply is achieved. Of units with a policy, 81.5% have a policy to guide discontinuation of DHM; most of these policies contain a corrected gestational age criterion. Healthy term newborns are granted access to DHM in 49.6% of units. Within 80% of units, parental/guardian consent is required to use DHM. The hospital budget covers funding for DHM in 80.7% of units, 20% is funded by insurance reimbursement, 3.7% by grants, and 16.5% are uncertain of coverage of DHM costs.

Conclusion(s): DHM access and use is common across U.S. NICUs; however, eligibility criteria vary widely. Most units are restrictive in DHM provision based on gestational age/birthweight criterion. Variable practices exist amongst policies used for discontinuation of DHM. This sampling suggests regional and pay variation and disparities within provision to different populations. Further research is needed to evaluate supply and distribution to inform policies to promote equitable access.