Donor Milk Availability in the Neonatal ICU: Surrogate for Change?

Dr Kantarowska and colleagues have brought welcome attention to the benefits of donor human milk for very low birth weight (VLBW, birth weight <1500 g) infants.1 Their intriguing study examines the relationship between the availability of donor human milk at the institutional level and: (1) rates of breastfeeding (provision of any breastmilk) at discharge among VLBW infants and (2) in-hospital rates of necrotizing enterocolitis (NEC), a severe and potentially lifethreating illness for VLBW infants. The authors astutely tapped into the data of a large and well-coordinated Perinatal Collaborative (California Perinatal Quality Care Collaborative), whose hospital members are served exclusively by the largest Human Milk Banking Association of North America donor milk bank in the United States. They were thus able to collect information on donor milk availability, breastfeeding rates, and rates of NEC for >90% of VLBW infants in California, the state with the highest (current) number of births over a 6 year period (2007–2013). This treasure trove of information produced the welcome and not surprising result that donor milk availability was associated, at an institutional level, with increased rates of breastfeeding at discharge and lower rates of NEC.