title: Variability of Criteria for Pasteurized Donor Human Milk Use: A Survey of U.S. Neonatal Intensive Care Unit Medical Directors.
abstract: BACKGROUND
  Use of donor human milk (DHM) is increasing, but criteria for its use are not well defined.
  
  
  METHODS
  We conducted a 34-question Internet-based survey of medical directors of U.S. level 3 and level 4 neonatal intensive care units (NICUs), with the goal of describing specifics of policies developed to guide DHM use in U.S. NICUs. Respondents reported NICU characteristics and details of policies concerning DHM use. Policy-specified criteria for DHM use, if any, were described. Bivariate and multivariate analyses were used to identify NICU characteristics associated with DHM use.
  
  
  RESULTS
  Respondents returned 153 (33%) surveys, with use of DHM reported by 91 (59%). Donor human milk use was more likely with more than 100 annual admissions <1500 g at birth (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.7) and with Vermont-Oxford Network participants (OR, 4.6; 95% CI, 1.8-11.6). Among 72 NICUs reporting a written policy, criteria for providing DHM required birth weights varying from <1000 to <1800 g and/or gestational ages from <28 to <34 completed weeks, but criteria were reportedly waived in many circumstances. Policies regarding duration of DHM therapy were similarly varied.
  
  
  CONCLUSIONS
  Criteria for initiating and continuing DHM vary widely among U.S. level 3 and level 4 NICUs. Donor human milk use is more frequent in NICUs with many very low-birth-weight admissions and among Vermont-Oxford Network participants. Further research is needed to define short- and long-term outcomes and cost benefits of DHM use in subgroups of NICU patients, particularly for uses other than necrotizing enterocolitis prevention.
authors.affiliation: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut Connecticut Human Milk Research Center, Hartford, Connecticut jhagadorn@connecticutchildrens.org.
authors.forename: James I
authors.initials: JI
authors.lastname: Hagadorn
authors.affiliation: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut Connecticut Human Milk Research Center, Hartford, Connecticut.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Brownell
authors.affiliation: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut Connecticut Human Milk Research Center, Hartford, Connecticut.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Lussier
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Margaret G K
authors.initials: MG
authors.lastname: Parker
authors.affiliation: Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut Connecticut Human Milk Research Center, Hartford, Connecticut.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Herson
mesh_terms: D001942:Breast Feeding; D003362:Cost-Benefit Analysis; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D016015:Logistic Models; D017784:Milk Banks / Q000706:statistics & numerical data*; D008895:Milk, Human; D015999:Multivariate Analysis; D061352:Pasteurization; D008486:Physician Executives; D011050:Policy Making; D011795:Surveys and Questionnaires; D014481:United States
keywords: donor human milk; prematurity; very low birth weight