The Financial Feasibility of Providing Expanded Access to Donor Milk for Newborns in the Hospital: An Integrative Review

Background: Hospital policies frequently limit use of donor milk (DM) to infants < 32 weeks gestational age (GA) and/or < 1500g and other limited conditions in part due to perceived scarcity of DM and high cost. Infants requiring supplements are often fed standard infant formula, despite best practice recommendations and family preference. Given the abundance of information about the health risks of formula use and impact on breastfeeding during the hospital stay we sought to understand the barriers related to cost for providing DM to all infants in the hospital.

Methods: We undertook a literature review to examine current evidence surrounding cost of DM as a barrier to use in infants >32 weeks GA and > 1500g requiring nutritional supplementation during their initial post-delivery hospital stay. The team queried PubMed, CINAHL, JBI, Cochrane using terms including Breast Feeding, Milk, Human, Milk Banks, donor, cost, and payment.

Results: The search yielded 536 unique results, after a title/abstract screening, 88 articles underwent full text review. Five articles answered the EBP question. The team synthesized three-level IIIA/B and two-level VA articles.

Conclusion: The literature revealed DM use is increasing in hospital infant populations to include those >32 weeks GA and >1500g. Hospitals are changing their criteria and policies to include DM for any infant who requires supplement to MOM including parental request for an exclusive breast milk diet throughout the hospital stay. Costs are successfully absorbed into the hospital budget and are increasingly supported by legislation.

Publication: As previously noted, this information is being presented at a hospital-affiliated Nursing Conference in April 2023.

Diversity and Inclusion: Presentation language is inclusive of all. Any language not diverse and inclusive is reflective of the articles that contributed to the project and not that chosen by the authors of this poster.

This study was also supported by the authors:
Nancy McAlduff – Nurse Lactation Consultant, Howard County General Hospital
Rachel Gordon – Utilization Review RN, Howard County General Hospital