Use of Donor Expressed Breast Milk in Maternity Hospitals and Neonatal Units in the Republic of Ireland

Background: Over the past decade, where mothers own milk is unavailable, use of donor expressed breast milk (DEBM) has become increasingly common, particularly in VLBW infants. Practices and opinions regarding DEBM use in the Republic of Ireland (ROI) have not previously been established.

Objective: To examine the current practices, opinions and knowledge regarding use of DEBM in Maternity Hospitals and Neonatal Units the ROI.

Methods: A standardized paper-based questionnaire was mailed to all Neonatologists and Paediatricians working in Maternity Hospitals and Neonatal Units in the ROI in 2016.

Results: Eighty-eight Paediatricians and Neonatologists were surveyed and 44 (50%) responded. Responses were received from 21 neonatal units, of whom 15 (71%) reported using DEBM. Fifty-three percent of units had a written DEBM policy, and significant variation existed in birthweight and gestational age thresholds for its use. Healthcare professionals were asked to indicate their level of agreement with a number of statements regarding DEBM. Twenty percent agreed that DEBM was more appropriate than formula use in healthy breastfed term neonates requiring supplementation and the same percentage agreed this practice increased long-term breastfeeding rates. One third of respondents agreed that the majority of trials supporting the use of DEBM to prevent necrotizing enterocolitis were conducted in the past 15 years, when the opposite is in fact the case. The main factors cited by physicians for not using DEBM in their unit were the specific population cared for in their unit, and inadequate access to DEBM.

Conclusion: Although donor milk is gaining considerable popularity, the criteria for its use are not well defined. This study identified wide variations in practice and deficits in knowledge regarding DEBM and indicates the need for a national guideline of evidence-based best practice for the use of DEBM for newborn infants in Ireland.