Top 10 research priorities for human milk banking and use of donor human milk: A partnership between parents and clinicians.

AIM: This study sought to establish research priorities in human milk banking and use of pasteurised donor human milk. It aimed to (i) collaborate with national stakeholders, including parents of preterm infants, human milk donors and health-care professionals, to identify evidence uncertainties and (ii) agree by consensus on a consolidated prioritised list of research questions. METHODS: A consensus approach modelled on the James Lind Alliance was used. A steering group was formed, and key stakeholder organisations identified. Evidence uncertainties were gathered through an online survey and literature search. An iterative process was used to consolidate and rank questions. A final workshop was held to identify the top 10 research priorities. RESULTS: A total of 391 evidence uncertainties were gathered from 202 respondents (38% parents of preterm infants/milk donors, 50% health-care professionals, 12% who identified as both a parent of preterm and health professional) and a further 15 were identified from literature. The steering group consolidated these to 39 evidence uncertainties, which were ranked via another survey. The top 24 questions were workshopped by 13 participants (four parents and nine clinicians) to determine the top 10 research priorities. These included the risks and benefits of using donor milk, optimum techniques for processing and the effects of these on the properties of milk, the nutrient profile of the milk and clinical criteria for prioritising receipt of milk. CONCLUSION: The top 10 research priorities in human milk banking and use of donor milk were identified and can be used to guide researchers.

Promoting early expression of breast milk in mothers of preterm infants in a neonatal unit: a best practice implementation project.

OBJECTIVES: The aim of this implementation project was to optimize lactation success in mothers of preterm infants by ensuring early (as soon as possible and within six hours) and frequent (eight to 12 times/day) milk expression. INTRODUCTION: Evidence suggests that breast milk improves enteral feeding tolerance and neurodevelopmental outcomes and decreases the risk of necrotising enterocolitis and late onset sepsis in preterm infants. It is widely accepted that breast milk expression should commence as soon as possible and within six hours of delivery. RESULTS: Following implementation of the breast milk expression information pack and staff education program, compliance to clinical guideline recommendations improved considerably. An increase from 5/20 (25%) to 17/20 (85%) of women expressing milk within six hours of delivery was observed. The average expression times also increased: from 2.6 (2.0) to 6.1 (2.7) times in the first 24 hours and from 4.6 (1.7) to 7.8 (1.7) times between 24-48 hours. The compliance rate for milk expression within six hours of delivery and expression of eight to 12 times daily in the first 48 hours increased from 1/20 (5%) at baseline to 10/20 (50%) in the follow-up audit. CONCLUSION: The implementation of the breast milk information pack and staff education led to improvements in the milk expression practices of mothers who had preterm infants. As a result of this project, the information packs are now routinely given to all women at risk of delivering preterm or who have babies in the neonatal unit. Further audits will be undertaken in the future to determine sustainability of practice changes.