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Re: Investing in human milk

Dear Editor,

The short commentary by Williams et al. is correctly labelled a perspective since it gives only one point of view about a complex subject. The systematic review by Boyd et al. in the same journal provides a carefully balanced overview of the evidence available and recommends further research on the effects of fortified or supplemental breast milk. The real issue however is encapsulated in the title of Williams' paper "Investing in human milk". Few would dispute that that the best source of milk is from the infant's own mother. It is not an easy process for anxious mothers or busy neonatal staff to express, safely store and subsequently prepare mothers own milk for administration and there needs to be significant investment in time and effort to achieve this. There are very few medical circumstances where a mother cannot provide milk for at least the first few weeks with appropriate support. In an area of the United Kingdom such as the North West where breast feeding rates in term infants are traditionally low it is possible to exceed 90% in the initiation of feeds for preterm infants using mothers own breast milk even without special resources(Audit M Turner 2005).

Williams et al. argue that donor milk is better than formula but perhaps this is the wrong question to be asking. Rather than investing heavily in a network of donor milk banks should we not be investing in the support of mothers to enable them to achieve expression of their own milk for as many weeks as possible in every neonatal unit? Should the cost effectiveness of this strategy not be assessed against the cost effectiveness of the donor milk banks? The meta-analysis by Boyd et al. has rightly shown that there are some advantages and disadvantages to donor milk over formula and has emphasised the lack of research. What we need is research evidence one way or the other as to the benefit of mothers own breast milk compared with donor milk. As Williams et al. suggest that the growth rate of infants fed preterm donor milk was similar to formula and greater than term breast milk and there are many other known benefits then surely we should work to ensure that all infants receive preterm milk from their own mothers

References:

1. Williams AF, Kingdon CC, Weaver G Banking for the future: Investing in human Milk Arch Dis Child Fetal Neonatal Ed 2007;92:F158-F159