Poster at Academy of Breastfeeding Medicine meeting Oct 2003 - in ABM News &
Views Sept 2003.
NEONATOLOGISTS’ ATTITUDES AND PRACTICE ON THE USE OF MOTHERS’ OWN AND
PASTEURIZED DONOR HUMAN MILK IN THE NICU. Nancy Wight MD, FAAP, IBCLC*, Medical
Director, Lactation Services, Sharp Mary Birch Hospital for Women, San Diego, CA,
USA.
Background/Aims: In its 1997 policy statement the American Academy of
Pediatrics stated: “Human milk is the preferred feeding for all infants, including
premature and sick newborns, with rare exceptions.” However, many
neonatologists do not use either mothers’ own milk or pasteurized donor human milk in the
nutritional care of their ill and premature patients. Under the auspices of
the State of California Breastfeeding Promotion Advisory Committee, a survey was
developed and administered to California neonatologists to ascertain their
knowledge, attitudes and practices regarding the use of mothers’ own, and donor
human milk in neonatal intensive care units around the state.
Methods: Self-administered surveys were distributed through the annual state
meeting of the California Association of Neonatologists (CAN) in 2001, with
supplemental surveys mailed to Neonatologists who did not attend the meeting.
The survey assessed knowledge and attitudes regarding both mothers’ own milk
(MOM) and pasteurized donor human milk (PDHM) for term and preterm infants using
a 5-point scale (strongly agree, agree, neutral, disagree, strongly
disagree). One hundred sixty four (164) surveys were returned completed, which
represents 35% of all California Neonatologists.
Results: Sixty-six percent of the respondents were male, and 78% had been in
practice > 10 years, with 31.7% in practice > 20 years! Although 97% of the
neonatologists usually or always encouraged mothers to provide breastmilk for
their infants, there were several areas of lack of information (neutral
response or wide spread of responses) and some areas of misinformation. For example,
fully 1/3 of neonatologists agreed with the statement that mothers’ milk is
sterile and most had no knowledge of how donor human milk is screened and
processed. Less than ¼ of neonatologists had ever prescribed pasteurized donor
human milk. Of those who had prescribed PDHM, most had used it for very few
patients, for indications of prematurity, feeding intolerance, post-surgical
nutrition or malabsorption. Most neonatologists were not sure of the availability
or how to obtain it for their patients. Other highly ranked concerns were
infection control issues and the nutritional adequacy of human milks for very low
birth weight infants. Over half the neonatologists who had not used PDHM were
concerned that an infant’s parents may not be receptive to the idea.
Conclusions: Through assessment of neonatal physician’s knowledge, attitudes
and current practices regarding the use of human milk in the NICU we hope to
devise educational strategies to provide accurate information regarding the use
of mothers’ own milk and PDHM where it exists, and support the use of human
milk, as appropriate, in the NICU environment.
Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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