My last
blog post discussed why breastfeeding is so important to an infant and how
medications can play a role in a woman’s choice to breastfeed. Today is going
to discuss the use of donor human milk in premature infants and how medications
play a role here.
Premature
infants are a unique patient population.
We know that breastfeeding has many benefits for all infants, premature
infants seem to gain even more benefits from this form of nutrition. Preemies,
especially very low birth weight infants, are at increased risk for
complications such as necrotizing enterocolitis, feeding intolerance, sepsis,
and developmental delays. The American Academy of Pediatrics states that “The
potent benefits of human milk are such that all preterm infants should receive
human milk.” (Landers)
With
this knowledge, one would think that breastfeeding rates are higher for this
population, but this is not true. Hospitals have adapted policies that
encourage breastfeeding to mothers of premature infants, but exclusive breastfeeding
is still difficult. These mothers have just undergone serious physiological and
physical challenges that they were not expecting. This level of emotion can
negatively impact the initiation of breastfeeding following delivery. Near the
end of pregnancy, mammary growth completes, mammary epithelium is prepared to
respond to the infant, and colostrum is produced, preparing for a full milk
supply. If a pregnancy is shortened, these things might not have occurred. Milk
production can be decreased due to stress, fatigue, and anxiety that many
mothers feel in this situation.
With
these factors, most NICU mothers of preterm infants were not able to provide
all of the milk necessary to feed their baby an exclusively human milk diet.
Formula was used at first, but efforts were in place to find another way to
provide human milk.
Milk
banks began to appear at big medical centers. These milk banks screened
potential donors for eligibility regarding their health and medication use.
They completed a blood test, physical exam, and medical forms. While mother’s
own milk still remains first choice for any infant, donor human milk offers a
viable alternative if the mother is unable to provide adequate nutrition for
her baby. (Landers)
We know
that milk from mothers of premature infants can be different than the milk that
mothers of term babies produce, so donor human milk was tested against babies
who received formula or exclusive mother’s milk. No significant different in
clinical outcomes regarding growth, anti-infectious processes, feeding
tolerance, neurodevelopment, or necrotizing enterocolitis were noted between
the use of mother’s own milk and pasteurized donor milk, but there was still an
advantage over formula. (Giuliani) The American Academy of Pediatrics
recommends using donor human milk for preterm infants if mother’s own milk is
insufficient despite lactation consultation. (AAP) Donor human milk has largely
replaced formula for nutrition supplementation following mother’s own milk.
In
order for a potential donor to pass eligibility, she must not be taking certain
medications. This is because babies in this population have immature systems
because they did not have the full opportunity to finish growing inside the
mother’s womb. Drug clearance and
metabolism rates might be different, which could cause a problem for an preterm
infant exposed to this drug even if a term infant was not affected. Medication use is not seen as an obstacle to
breastfeeding most babies, but the different in anatomy and development might
pose a problem. Current milk bank
guidelines in the United States are that the only acceptable medications are as
follows: prenatal vitamins, human insulin, thyroid replacement hormones, nasal
sprays, asthma inhalers, topical treatments, eye drops, and progestin-only
birth control products. This limits the amount of eligible potential donors.
(HMBANA)
In the last year, Human Milk Bank
Association of North America has been studying this topic. They put together a
team of medical professionals, including pharmacists and pharmacologists, to
determine whether certain medications are proven scientifically safe for donor
mothers to take while donating their milk. Although the guidelines have not
been released yet, it is rumored that they will be much more inclusive, to
allow for other common medications to be taken by the mother. However, each
individual milk bank has the option of accepting items that are deemed “acceptable”
by these guidelines. It will be interesting to see the new guidelines and to
see how the milk banks react to these.
Look for a future blog post on this
subject.
Alexis Ireland, PharmD Candidate 2014
References
“Breastfeeding
and the Use of Human Milk.” Pediatrics
129 (2012): 826-42.
“Donate Milk.” HMBANA.
Landers, Susan MD
and Hartmann, Ben PhD. “Donor Human Milk Banking and the Emergence of Milk
Sharing.” Pediatr Clin N Am 60
(2013): 247-60.
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