Background: Exclusive human milk feeding during the hospital stay after birth is a standard for best practices and optimal infant health outcomes. Hospital policy can limit use of donor milk (DM) to infants < 32 weeks gestational age (GA) and/or < 1500 g, and for other limited conditions, in part due to perceived scarcity and the high cost of DM. When other breastfed infants outside of these groups require feeding supplements, they are frequently given formula, often despite family preference.
Aim: We used the Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals Model and Guidelines (Dang, 2022) for this Evidence-Based Practice project, to answer the research question: What is the current literature on the financial feasibility of providing donor breast milk to infants > 32 weeks GA and/or > 1500 g with a medical need?
Narrative: The team queried PubMed, CINAHL, JBI, and Cochrane, using terms including breast feeding, milk, human milk, milk banks, donor, cost, and payment. Articles published between 2011 and 2022 were included if they had a financial component and spoke to a medical need for supplementation above mother’s own milk produced, or milk from milk banks/Prolacta, within hospitals in North America. Studies of infants < 32 weeks GA or infants who weighed < 1500 g were excluded. The search yielded 536 unique results, and after a title/abstract screening, 88 articles underwent full text review. Five articles answered the evidence-based practice question. The team synthesized three level IIIA/B and two level VA articles. Cost is not perceived as a barrier to using DM for any infant requiring supplemental feedings among the hospitals reported in this review. These hospitals incorporate DM into the hospital operational budget in recognition of its financial value toward an exclusive human milk diet during the initial hospital stay after birth. To align with global and national recommendations, these hospitals do not differentiate sub populations regarding eligibility for donor milk. DM is the preferred dietary supplement to mother’s own milk, regardless of clinical indication for supplementation, including parental request. Additional reimbursement options for DM include insurance, partnerships with milk banks, self-pay, and grants. Translation of synthesis revealed that perceived costs do not align with actual costs when DM is used in practice.
Conclusion: To address ongoing acceptability concerns we recommend a retrospective chart audit to compare the cost of infant formula to donor milk feedings in infants outside of the current DM-approved population. Based on these results we also recommend a pilot study with an education component to offer DM to any infant requiring supplementation to assess for fit and feasibility. If successful the pilot can be expanded across the newborn in-patient population.
