Thoughts on using donor breast milk in NICU?

TiffyRN, BSN, PhD · Oct 25, 2011

The unit where I work uses donor EBM extensively. I haven't seen formula given to a young micro-preemie in years. The neos explain to the parents of all premature infants if we expect to give donor milk and they have to outright refuse it, otherwise the kids will get it (with a preference always given to maternal EBM). We haven't had the parent of a micro refuse, a few of the 32-34 week group have had moms refuse, but donor EBM is rarely ordered for kids over 32-34 weeks.

I remember feeding PE 20 to micros as trophic feedings. The thought of doing that now just makes me shudder. We have also transitioned to using the human milk fortifier Prolacta in the last couple of years. According to the powers that be, our rates of NEC have dropped dramatically. All kids under 28 weeks and I think it's 1500 grams get all maternal or donor EBM. This will eventually be fortified with Prolacta until they are 34 weeks adjusted then they are either continued on maternal EBM which is then fortified with powder (cow-based) HMF or if there is no maternal EBM they are transitioned to formula at that point.

Our donor milk comes in 100ml bottles. Many kids in our unit are on donor EBM. Because of that we are able to share a few mls from one kid's bottle (as long as nothing has been mixed in) to the little ones that need trophic feeds. The milk is pasteurized and because of this they tell us it is safe to use for up to 48hrs after defrosted as long has nothing has been added to it.

Our milk bank is non-profit using all donated milk. Many of the donations come from our patient's moms who have a really good supply or either who (sadly) have a loss. Many times those moms feel a small measure of comfort that the milk they had been pumping for so long (and freezing in our unit) will help some other preemie or sick infant.

NicuGal, MSN, RN · Oct 26, 2011

When we use it, we have to have a permit signed, an informed consent. We have had moms refuse. Nothing much you can do about it. We try to get all moms to pump for at least 4 weeks. We aren't allowed to share bottles between patients, which is a waste IMO. Eventually we are getting a "milk room and milkmaid" who will draw up our feeds, label them and place them in the kid's bin in the room fridge.

Elvish, BSN, DNP, RN, NP · Nov 2, 2011

We have a milk bank at my hospital. We use it IF the parents consent. Most do, esp those who have EL/VLBW babies. I think the cutoff at which we no longer use DBM is 32 weeks (of course, mom's EBM is always welcome :) ).

Once it's thawed out post-pasteurization, we have 24 hours to use it all or we have to throw it out. And, we are allowed to use one bottle for multiple babies provided we are pouring milk out of the bottle versus sticking a syringe into the bottle to draw it up. Our premie milk also comes in 2oz. portions so we would be wasting a good bit as well.

NICURN29 · Nov 2, 2011

We use donor milk in our unit, and it is not based on consent in our state. We use it on any babies that are 1000g or less at birth, and we continue to use it until they reach 34 weeks (or will stop it sooner if by physician order). We also use human milk-based fortifier in babies born at 800g or less and continue using that until they reach 34 weeks. Of course, we give preference to mother's milk when it is available. We are able to share the thawed donor milk among several babies, and we do not seem to throw much away, if we are careful.

NicuGal, MSN, RN · Nov 2, 2011

I'd be curious as to how you get around not having consent, it is a body fluid even if it is pasteurized.

NICURN29 · Nov 2, 2011

In our state, feeding choices are not one of the things for which consent is needed. Therefore, we are following the state law when we do not require consent to feed donor milk. Every state is different, so it might be different where you are.

TiffyRN, BSN, PhD · Nov 2, 2011

I'd be curious as to how you get around not having consent, it is a body fluid even if it is pasteurized.

I don't know the exact legalities, but I would guess I am in one of those States that considers EBM administration to be a feeding choice. We have a form that we are to have the parents read and sign, but it is called an "information sheet" and does not need to be signed before the Donor EBM is started. Donor is only not given if a parent refuses.

I can only think of one family that did and their child wouldn't have been considered a micro, but was young enough/small enough to qualify for Donor (though probably wouldn't have qualified for Prolacta).

And also, this is kind of one of my pet peeves. . .

We give donor cow milk indiscriminately. Nobody calls it that, but that's what it is. It never ceases to amaze me how people forget that. I call it that on and off just to get the point across. Human donor milk is far more tested than cow's milk (which is pretty well monitored and tested).

And I'm not even an LC or anything, but I feel strongly about sick infants (read fetuses in many cases) getting human milk.

NicuGal, MSN, RN · Nov 3, 2011

Interesting. We can't begin giving DBM until the parents have been informed. If we gave it and a parent didn't want it that could be potentially ugly. You can educate people out the wahoo but it doesn't mean they are going to see it our way Oh I agree on EBM being tested more than formula, no argument there. We are pretty successful at getting a lot of the micro kids moms to pump at least a few weeks, most will for at least 4 weeks. The other problem we run into is that some insurances will not pay for DBM, stupid in my opinion. These insurance companies need to get with the times.

TiffyRN, BSN, PhD · Nov 3, 2011

Interesting. We can't begin giving DBM until the parents have been informed.

It is my understanding that the when the doctors talk to the mom/parents they review the basic plan of care and if donor EBM is recommended, they review it with the parents. It would be up to the parents to protest that particular item. I know this is different than some States and even other facilities (and even our policy a few years ago). I always review with the parents if we are giving it and get the information sheet signed if it has not yet been done.

I've been a nurse long enough to remember when we gave blood (to adults) without written consent. Just verbal if the patient was awake and alert. Same as starting an IV or inserting a catheter. In the aftermath of HIV/AIDS it became routine to get written informed consent.

Albumin is a blood/body fluid that does not require consent. It has a (small) chance of transmitting diseases.

dawnebeth · Nov 10, 2011

Nearly all our micro-preemies and babies with gut damage are on Breast milk or banked Breast milk. When only a tiny portion is needed, we do a partial thaw. Let the bottle thaw just enough that the milk closest to the glass thaws and the core in the middle is still frozen. Pour that thawed milk off, write partial thaw, the time and date on the frozen bottle and put it back in the freezer. Then label the small thawed milk in a similar way with the baby's name, etc and put it in the fridge for use in that shift or 24 hours.

NicuGal, MSN, RN · Nov 10, 2011

That really is not best practice to refreeze milk that has partially been thawed. If you are using it within 24 hours, then just let it thaw all the way.