AAP warns against use of unscreened, internet-purchased breast milk
A joint policy statement released by the AAP’s Committee on Nutrition encouraged health care providers to advocate for screening, pasteurization and distribution of donor human milk through approved milk banks to ensure its safety for high-risk infant consumption.
Jointly issued with the AAP’s Section on Breastfeeding and the Committee on Fetus and Newborn, this policy statement recommends against the use of internet-purchased donor milk or informal human ‘milk sharing’ due to the risk for bacterial or viral contamination, as well as medication, drug and herbal exposure.
“Donor milk banks represent a safe and effective approach to obtaining, pasteurizing, and dispensing human milk for use in NICUs and other settings. However, accessibility to donor milk in the United States continues to be substantially limited in terms of supply, cost, and distribution,” Steven A. Abrams, MD, past member of the AAP Committee on Nutrition, and colleagues wrote. “Because of these limitations, some parents have chosen to exchange human milk that is not pasteurized or handled by an established milk bank with each other.”
Donor human milk is particularly important for very low birth weight infants, with recent evidence supporting its benefit as a supplement to the mother’s own milk as well as contributing to a decrease in the rate of necrotizing enterocolitis.
However, the policy statement noted, cost reimbursement remains a significant barrier to providing donor human milk to hospitals or families. According to researchers, reimbursement for donor milk is inconsistent between states and often varies between sources of payment. Additionally, the AAP has noted a lack of federal or state guidelines in place to oversee the preparation, handling and transfer of human milk and ensure that human milk sold via the internet adhere to screening standards.
“Informal direct milk sharing without pasteurization exposes infants to a range of possible risks, including bacterial contamination and viral transmission, including cytomegalovirus, hepatitis viruses, and HIV,” Abrams and colleagues wrote. “Individual screening is performed by some internet-based groups that organize direct milk sharing, but these are neither consistently applied nor documented.”
In addition to advocating improved governmental oversight and funding support for donor milk banks, the policy statement provides recommendations for developing public policy to increase and expand access to safe donor milk including:
- While milk from an infant’s own mother is preferred, donor human milk may be used for high-risk infants when the mother’s milk is not available or the mother cannot provide milk, especially among infants less than 1,500 g birth weight;
- Human milk donors should be identified and screened with methods similar to those employed by the milks banks of Human Milk Banking Association of North America or other established commercial milk banks;
- Donor milk should be pasteurized within accepted standards with postpasteurization testing performed to adhere to set internal quality-control guidelines;
- Due to the elevated risk for infectious or toxic contaminants, health care providers should discourage families from direct human milk sharing or purchasing human milk from the Internet; and
- Policies are required to enable access to donor human milk for high-risk infants based on documented medical necessity, rather than financial status.
“Neonatologists and other health care providers should advocate for policies of full disclosure of the risks and benefits related to direct or informal milk sharing without pasteurization,” Abrams and colleagues wrote. “Hospitals should develop standards such that all human milk given to infants meets appropriate standards for preparation and distribution and that pasteurization of all donor human milk occurs.” — by Bob Stott
Disclosure: The researchers report no relevant financial disclosures.