Neonatal intensive care clinicians understand the positive impact of an exclusive human milk diet for their patients, especially those most at risk. The positive impact makes it easier to prioritize support for mothers to pump, and to acquire donor milk when mother’s own milk is not available. Level III and IV NICUs find donor milk increasingly valuable for their preterm infant population. Donor milk use is on the rise not just in the NICU, but also in level 1 newborn care units.1
While it may seem simple to obtain and use donor milk, the reality can be much different than the initial expectation. Let’s look at expectations and assumptions, the actual reality, and how to connect them for a positive outcome to benefit your patients.
Expectation #1: Donor milk acquisition will be easy
Donor milk has thankfully become more available in recent years, although improvements are always needed. A hospital has several options to choose from. Those options include companies which collect and either sterilize or pasteurize donor milk, large and small donor milk banks, or in-house donor milk banks within the individual hospital or healthcare system.
At first glance it may seem like an easy process to acquire the needed donor milk. But there are a variety of factors to consider.
The milk may be frozen or shelf stable, which can impact how your team will use the donor milk and how much preparation time will be necessary. Prepare yourself for due diligence of resource gathering and research. Collect feedback from donor milk providers to understand how working with them will impact your workflow before making a decision.
Questions to ask a donor milk provider:
What is the ordering process?
How long will shipping take?
Can you increase the volume of your orders if needed?
Is there a possibility of shortage?
Are there special requirements for shipping and receiving the donor milk to our facility?
What are the recommended processes for receiving and storing?
What are recommended best practices for handling the donor milk?
Understanding those key points can help you identify the best solution for your hospital, including the acquisition process and future ordering.
Expectation #2: Donor milk storage won’t require much space
Collecting mother’s own milk and storing in your NICU may not take up much space yet. If you’re lucky, those mothers are visiting frequently and able to drop off a few more storage containers for the freezer or refrigerator every few days as their most recent contributions are used.
But storing milk for dozens of infants who do not have access to mother’s own milk or need supplemental human milk nutrition is another matter. Donor milk storage can have an impact on space in your unit.
Do you have enough freezer and refrigerator space to scale to your goals of supplying human milk to as many infants as possible? (if using a frozen option)
Where are freezer and refrigeration appliances located in the unit? How does that impact feeding and nursing efficiency?
Are those appliances easy to clean and maintain with recommended best practices for human milk storage?
Does your team fully understand how long human milk can remain frozen or refrigerated?
The Centers for Disease Control (CDC) published Human Milk Storage Guidelines for the safety of proper human milk storage:
It is imperative to fully understand space and appliance requirements along with best practices in handling human milk. Thawing human milk also has strict guidelines to ensure its safe delivery.
You can eliminate the need for thawing and freezer space if your unit opts to utilize a shelf-stable option for donor milk feeding. Shelf-stable indicates the sterilized human milk can be stored at room temperature until the packaging has been opened, at which point it is refrigerated. Benefits to the shelf stable donor milk option are reduced electrical appliances needed for frozen milk, more storage options throughout the unit and at the bedside, and the removal of thawing steps (along with the potential for milk waste).
Given the at-risk nature of NICU patients, proper care and handling of donor milk is critical, and should be governed even more carefully than a home environment.2 Continued education for your nursing staff should be available, especially when dealing with frozen donor milk options, to ensure awareness and understanding of best practices.
Expectation #3: Donor milk thawing time won’t interfere with nursing efficiency
If your unit is using a frozen donor milk option, and your goal is to provide donor milk to every baby, efficiency will be impacted.
While your unit defrosting process may include refrigerator defrosting or running frozen pouches under warm water, both require steps and nursing time to accomplish. Your nursing staff will need to anticipate more thawing steps and thawing time as your donor milk use increases. Be aware of the time investment to ensure it does not become a logistical surprise down the road.
Your team can mitigate that time investment by using a shelf-stable donor milk solution with no freezing or defrosting requirements.
Donor milk: The reality is worth it!
Adopting more donor milk into your hospital will benefit your patients. Your work to identify the right donor milk provider for your unit, educating your team, and anticipating those additional steps can make a world of difference in the successful adoption of such an initiative.
Ask questions, consult with your teams, and work closely with your donor milk provider for the best outcomes, for team efficiency and workflow, and the infants in your care.
1. Belfort MB, Drouin K, Riley JF, et al. (2018) Prevalence and trends in donor milk use in the well-baby nursery: A survey of Northeast United States Birth Hospitals. Breastfeeding Medicine 2018;13:34–41.
2. Steele, C. (2018) Best Practices for Handling and Administration of Expressed Human Milk and Donor Human Milk for Hospitalized Preterm Infants. Frontiers in Nutrition. Accessed online March 11, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129589