January 2016

Research on Human Milk Helps Get Infants Off to a Good Start

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While human milk feedings are important for all children, they can be a medical intervention that makes the difference between life and death for critically ill infants at The Children’s Hospital of Philadelphia.

Human milk protects babies from significant disease and medical problems, such as necrotizing enterocolitis, a serious intestinal illness in infants. Growth hormones in human milk help to develop infants’ intestinal systems, and other properties strengthen babies’ immune systems, protect their eyes and brains, and foster neurodevelopment. Another plus is that human milk is easy to digest, which facilitates transitioning of critically ill babies off parenteral (intravenous) nutrition.

These are just a few of the benefits of human milk that new moms with infants at CHOP learn as part of the hospital’s robust Breastfeeding and Lactation Program led by Diane Spatz, PhD, RN-BC, an internationally known expert in the field. About 600 specially trained breastfeeding resource nurses at CHOP provide support to breastfeeding mothers and families, creating a hospital culture that values the provision of human milk.

Dr. Spatz, who also is a researcher and the Helen M. Shearer Term Chair in Nutrition and professor of Perinatal Nursing at the University of Pennsylvania’s School of Nursing, has published a plethora of studies over two decades, many focusing on breastfeeding and medically fragile infants. Her findings have contributed to CHOP’s development of a state-of-the-art Human Milk Management Center and a new on-site human milk bank for hospitalized infants. Yet, human milk science remains largely unexplored.

“The amount of research that needs to be done about human milk and breastfeeding is phenomenal,” Dr. Spatz said.

Making a Big Difference

In a recent study published by Dr. Spatz and colleagues at the Center of Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, they looked at a national sample of 97 neonatal intensive care units (NICUs) and found that NICUs with better work environments and better educated nurses who provided breastfeeding support had higher rates of very low birth weight infants who were discharged on human milk.

“This research is important because we know that not all hospitals do the best job in providing evidence-based lactation support and care,” Dr. Spatz said of the study that appeared in the International Journal of Nursing Studies. “What we do at CHOP and our messaging about the importance of human milk is so unlike what many hospitals do; that is why we have such amazing outcomes for our mothers and our infants.”

For example, any family who comes to CHOP’s Center for Fetal Diagnosis and Treatment and has a baby identified prenatally with a congenital anomaly receives a personalized, tailored, one-on-one prenatal intervention teaching them about human milk and the importance of pumping for their critically ill infant. This approach has resulted in a virtually 100 percent pumping initiation rate, which is remarkable when compared to national averages in the U.S. that show only about 79 percent of mothers start pumping for their babies. In Pennsylvania, CHOP is tied for number one in all birthing units for its breastfeeding initiation rate.

At the time of discharge from CHOP, 86 percent of  NICU infants go home on human milk (if the infant was born in the Special Delivery Unit or admitted within the first seven days of life). Dr. Spatz and her colleagues wanted to know how long mothers kept breastfeeding for post-discharge, so they conducted a study that followed 165 babies who were born in CHOP’s special delivery unit and then cared for in the NICU. Both the mean and median breastfeeding rate post-discharge was eight months. The duration of breastfeeding/provision of human milk ranged from one week all the way up to 30 months. Results of this study appeared in the Journal of Obstetric, Gynecologic, and Neonatal Nursing.

“This shows that the way we provide care makes a big difference in terms of keeping our infants healthier and also to their mothers being able to achieve their personal breastfeeding goals,” Dr. Spatz said.

Using Donor Milk, An Empowering Practice

Building on the success of the Breastfeeding and Lactation program, in November CHOP opened the Mothers’ Milk Bank, which provides donor human milk that is pasteurized and processed on-site to infants who are hospitalized at CHOP. The CHOP Mothers’ Milk Bank was developed in cooperation with the Human Milk Banking Association of North America (HMBANA), a professional organization that sets the standards and guidelines for nonprofit donor milk banking in North America. It is one of the only nonprofit milk banks located inside a freestanding children’s hospital in the U.S., and donations from mothers of hospitalized CHOP patients began in January.

“The milk is a very safe product,” Dr. Spatz said. “That being said, donor milk is not the same as mom’s own milk — mom’s own milk is always the best because it is specifically tailored to her own child. But donor milk is a very important alternative if mom’s own milk is not available or if for some reason it is contraindicated. At CHOP, we consider donor milk to be a bridge to mom’s own milk or a support.”

An exciting aspect of having an on-site milk bank is that it opens new opportunities for research. Donor human milk offers many of the same advantages as maternal milk such as easy digestibility, but more research is needed to demonstrate if it confers the same benefits in regard to specific health outcomes. Another big question: What are the ideal dosages of donor human milk needed in order to achieve those positive responses?

Already in progress, Dr. Spatz and co-investigators are conducting a retrospective study that covers a four-year period and focuses on all babies at CHOP who received donor milk. The study team will take a close look at the doses and volume of donor milk the babies received, for how many days they received donor milk, and how much this care cost.

“When you look at the cost compared to other medical interventions in the neonatal care unit, the cost of providing donor milk is really quite low,” Dr. Spatz said.

And the benefits to mothers may be priceless. Providing human milk is integral part of motherhood, especially when infants are critically ill. Mothers in this vulnerable situation often feel desperate to comfort their children, and expressing milk becomes a way for them to help their children in a way that no one else can do. Many are eager to share this sense of empowerment by donating milk that may be used when another mom’s milk supply is still being established or when a mom experiences a low milk supply. One of the first donors to the Mother’s Milk Bank had a baby being cared for in CHOP’s NICU, and the mother was pumping about a liter of milk a day.

“Here is a mom who is not only helping her own child, but she is helping countless other children,” Dr. Spatz said. “When she spoke at the press conference announcing the Mother’s Milk Bank, she said, ‘When my baby started getting my milk, I saw how much she grew and thrived, and to know that I can give my extra milk to help other babies grow and thrive and be healthier, it is so rewarding.”

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