Understanding the current and future usage of donor human milk in hospitals: an online survey of UK neonatal units

Abstract

AbstractObjectiveThe use of donor human milk (DHM) where there is a shortfall of maternal milk can benefit both infant and maternal outcomes but DHM supply is not always assured. This study aimed to understand current DHM usage in UK neonatal units and potential future demand to inform service planning.Design/SettingAn online survey was disseminated to all UK neonatal units using SmartSurvey or by telephone between February and April 2022 after development alongside neonatal unit teams.ResultsSurveys were completed by 55.4% units (108/195; 18 Level 1, 47 Level 2, 41 Level 3; cot numbers 9-56) from all thirteen Operational Delivery Networks. Only four units reported not using DHM, and another two units only if infants are transferred on DHM feeds. There was marked diversity in DHM implementation and usage. Five of six units with their own milk bank had needed to source milk from an external milk bank in the last year. Ninety units (84.9%) considered DHM was sometimes (n=35) or always (n=55) supportive of maternal breastfeeding, and rarely supportive by three (2.9%). Usage was predicted to increase by 37 units (34.9%), driven by parental preference, clinical trials, and improved evidence.ConclusionsThese findings support the assumption that UK hospital DHM demand will increase after updated recommendations from the WHO and British Association of Perinatal Medicine. This data will help policymakers and milk banks to plan strategic service delivery, alongside ongoing cost-benefit analyses, donor recruitment strategies and infrastructure planning to ensure equity of assured access to DHM nationally.What’s known, what does this study add?What is already known on this topicUpdated recommendations from WHO and BAPM are likely to increase demand for donor human milk provision from human milk banks, but there have been no recent data collected on baseline usage criteria, enteral feeding guidelines, and anticipated future use.What this study addsThis national survey of UK neonatal units highlights variability in DHM provision, and reasons for demand spikes that will be helpful for modelling future services. Almost 85% of neonatal units responded that DHM availability was supportive of maternal lactation support. DHM demand is likely to increase further in the next 2 years.How this study might affect research, practice or policyUnderstanding demand variability will help in planning nationally equitable human milk bank services, and support the development of robust national service continuity planning. The study also highlights variability in practice, often in single regions, raising concerns related to health equity, staffing limitations and uncertainty in DHM implementation.