The Financial Feasibility for Providing Expanded Access to Donor Milk for Low-Risk Preterm and Full-Term Newborn Infants: An Integrative Review

Abstract

Background:

More than 20% of newborn infants in the United States are fed formula to supplement breastfeeding in their first 2 days. Most hospitals that provide pasteurized donor human milk (PDHM) for supplemental feeding limit its use to infants <32 weeks’ gestation or <1,500 g at birth. Cost is one perceived barrier to PDHM use among late preterm or full-term infants that do not meet premature age or low birth weight criteria.

Objectives:

The aim of the project was to identify and describe the current literature on the financial feasibility of providing donor breast milk instead of formula among a wider population.

Methods:

We performed an integrative review using The Johns Hopkins Evidence-Based Practice Model framework for article appraisal. The search used PubMed, CINAHL and JBI electronic databases for articles from 2011 to 2022.

Results:

From 536 articles retrieved, five met criteria for inclusion. Analyzed articles reported on trends, indications, costs, and accessibility of PDHM. Results revealed various methods of incorporating PDHM in their operational budget.

Conclusions:

Use of PDHM instead of the formula is increasing for supplementation. Facilities using PDHM beyond these limits have included its costs in their operational budget. This article reveals the multifactorial elements that contribute to the cost of PDHM, thus underscoring the lack of evidence demonstrating cost as a barrier to providing PDHM for infants >32 weeks or >1,500 g. More studies are needed to identify the cost-benefit ratio of the use of PDHM for this population.