• Infant Feeding
• Neonatology
• Nutrition

Maternal breast milk is the best source of enteral nutrition for preterm or low birthweight infants. With insufficient volumes of maternal breast milk, donor-expressed breast milk (DEBM) or artificial formula are two common alternatives. Despite publication of a recently updated Cochrane review1 demonstrating a decrease in the risk of necrotising enterocolitis (NEC) in babies receiving DEBM compared with those receiving formula, concerns about the methodological quality of some of the included studies, their applicability to current neonatal practices (the majority of included trials were carried out in the 70 s and 80 s), the slower in-hospital growth rates of those on DEBM and the fact that growth-restricted premature infants as well as unwell infants were generally excluded from these studies,1 continue to cause confusion. We wanted to establish a national picture regarding use of DEBM.

All 211 Neonatal Units in the UK were contacted by telephone between May and July 2013; 201 units (95.3%) were able to complete the survey (54 special care baby units, 90 local neonatal units and 57 neonatal intensive care units). Of the 201 units, 122 (60.7%) reported initiating infants on DEBM (see figures 1 and 2). All units using DEBM reported obtaining parental consent prior to its commencement and 96.7% of these units had protocols governing DEBM storage and use. 67 of the 122 units (54.9%) responded to questions attempting to better understand the criteria used to initiate DEBM: 31 units reported using gestation, 21 units birth weight, 11 units absent or reversed end-diastolic flows and 8 units used intrauterine growth restriction in their guidelines. There was wide variation in the cut-offs used for gestation and birth weight definitions. Two units reported using DEBM in cases of gastrointestinal-tract surgery (non-NEC) and another two units reported using it in neonates with a diagnosis of congenital heart disease. Length of DEBM use varied from 7–60 days with a mean length of 3 weeks. Twelve units reported using DEBM on the postnatal wards including in their healthy term babies.

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Figure 1

Percentage of donor-expressed breast milk use by level of designation of neonatal units. SCBU, special care baby units; LNU, local neonatal units; NICU, neonatal intensive care units.

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Figure 2

A map showing the location of all the neonatal units that responded to the questionnaire. Red dots represent those units that initiate donor-expressed breast milk while those in white represent units that do not. Blue dots represent milk banks.

The most commonly reported limiting factors for those not using DEBM were cost (64.6%) and access to DEBM (49.3%). This latter reason and the clustering of units initiating DEBM around Milk Banks might suggest that having more Milk Banks could further increase use of DEBM. Alternatively, it could be that Milk Banks are actually set up in response to local demand for DEBM, and some of the interviewees suggested that there might be acceptability issues in some communities.

Acceptability of DEBM to various communities and whether Milk Banks drive use of DEBM are subjects worthy of further study. There is also an urgent need for appropriately powered, multicentre, blinded, randomised, controlled trials comparing DEBM and formula feeds in the modern era. These should be designed in such a way so as to allow meta-analyses that will definitively answer some of the issues that are currently dividing the neonatal community.