Human Milk Donation in Aotearoa New Zealand

Abstract

Introduction: Mother’s own milk (MOM) provides optimal nutrition for infants. When MOM is unavailable or insufficient, donor human milk (DHM) is recommended. Feeding DHM instead of infant formula (IF) to low birth weight and very preterm infants is associated with a reduced risk of serious gastrointestinal infection. However, there is limited research investigating DHM use in low-risk populations, including moderate-late preterm (MLP) and early term (ET) infants. Little is known about human milk (HM) donation practices in New Zealand (NZ), where access to HM banks is limited. This thesis aimed to explore mothers’ and health professionals’ (HP) views and experiences of HM donation in NZ and summarise the available literature regarding the benefits and risks of DHM use in MLP and ET infants. Methods: Key databases were systematically searched for ongoing and completed randomised and observational studies comparing DHM versus IF to supplement MOM in MLP and ET infants. Characteristics of identified studies were summarised. In addition, two electronic surveys were circulated via social media to mothers and HP involved with HM donation in NZ. The surveys included questions on mothers’ and HP demographics, experiences and perceptions of informal HM donation. Descriptive and thematic analyses were undertaken using SPSS and NVivo, respectively. Results: Seven studies fulfilled the inclusion criteria of the systematic review, of which 2033 infants received DHM as a supplement or substitute to their MOM. Most of these studies were from the United States and investigated neonatal hypoglycaemia and breastfeeding outcomes. Five ongoing randomised controlled trials were identified, exploring a range of biochemical, anthropometric and infant health outcomes. The HP survey (n=283) reported that DHM was available in 86% of workplaces and most frequently used for full-term infants (71.8%). Almost all respondents supported DHM use in hospitals (98.6%) and pasteurisation of DHM was reported by 56.5% of HP. Qualitative analysis demonstrated that HP felt HM donation could improve with better advocacy, access, affordability and guideline development. Most mothers (n=496) donated (51.5%) or sought DHM (25.6%) for their infant and arranged DHM exchanges between individuals (51.9%). Most HM donors were satisfied or extremely satisfied with their HM donation experience (90.8%). Mothers felt informal milk sharing was beneficial to infants’ health (e.g., improved immunity) and avoided exposure to IF. However, mothers had concerns regarding the composition of DHM (e.g., contamination) and how this may impact infants’ health. Benefits of informal HM donation for the donor were highlighted (e.g., altruism), though negative implications were also identified (e.g., oversupply). Conclusion: Systematic review of the literature demonstrated limited evidence on the clinical effects of using DHM instead of IF to supplement MOM in MLP and ET infants. High-quality research on this practice's potential benefits and risks for this population is required. Furthermore, this thesis provides first insights into HM donation in NZ. Results indicated that HM donation is widely supported and common throughout the country. Future interventions are needed to support safe and equitable access to DHM in NZ.