Peer-reviewed article
Impact of Access to Pasteurised Donor Human Milk on Rates of Necrotising Enterocolitis in Neonatal Units in Australia: A Cohort Study.
Klein LD, Lui K, Chughtai AA, Osborn DA, Guaran R et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether access to pasteurised donor human milk (PDHM) from a national service reduced necrotising enterocolitis (NEC), a serious infection of the bowel in premature babies. Researchers compared health outcomes for very premature infants (born before 32 weeks) in 15 Australian neonatal units before and after PDHM became available from 2018 onwards. Infants born before 28 weeks who had access to PDHM had 38% lower rates of NEC. However, babies weighed slightly less at discharge when PDHM was available, and there were no differences in breast milk feeding, infections, or death rates.
Key points
- NEC risk was 38% lower for infants born < 28 weeks' gestation when Lifeblood PDHM was available (aRR 0.62, 95% CI 0.46-0.83)
- Weight at discharge was lower when PDHM was available (2828.8 g vs. 2939.56 g, p = 0.001)
- Breast milk feeding at discharge, infections and death were not associated with PDHM availability
- Study included 4,395 infants born < 32 weeks' gestation across 15 NICUs over 3 years (2018-2020)
- Before 2018, most Australian NICU infants did not have reliable access to PDHM despite five milk banks operating
Limitations
This is an observational cohort study without randomisation, so causation cannot be definitively established and unmeasured confounding factors may have influenced results. The study cannot explain why discharge weight was lower with PDHM available, which requires further investigation.
Abstract
Background and aim In 2018, a pasteurised donor human milk (PDHM) service was established within Australia's national blood service, Lifeblood, and subsequently expanded to a national service. Before 2018, five milk banks operated in Australia, but most infants admitted to Australian neonatal intensive care units (NICUs) still did not have access to PDHM. This study aimed to compare infant outcomes before and after Australian NICUs had access to an assured supply of PDHM from Lifeblood. Methods Cohort study utilising Australian and New Zealand Neonatal Network data for infants born < 32 weeks' gestation admitted to 15 NICUs across Australia over a 3-year period (2018-2020; n = 4395 infants). The primary study factor was NICU access to an assured supply of PDHM from Lifeblood. Neonatal outcomes were compared in periods with "PDHM available" versus "PDHM not available". The primary outcome was the proportion of infants born < 28 weeks' gestation who developed NEC. Secondary outcomes included duration of parenteral nutrition, retinopathy of prematurity, infection, death, length of stay, weight at discharge, and breast milk feeding at discharge. Results After adjusting for confounding risks, NEC relative risk was 38% lower for infants born < 28 weeks' (aRR 0.62, 95% CI 0.46-0.83) when Lifeblood PDHM was available. Weight at discharge (2828.8 vs. 2939.56 g, p = 0.001) was lower when PDHM was available. Breast milk feeding at discharge, infections and death were not associated with PDHM availability. Conclusions Reliable access to PDHM was associated with reduced risk of NEC for infants born < 28 weeks' gestation in Australian NICUs.