Breast milk is considered to be the best the optimal source of nutrients for babies especially those weighing below 1,500 grams when they are born. The benefits obtained from a mother’s own milk include improved the maturity of the gastrointestinal system, better tolerance for feeding and a reduced risk of infections that are life-threatening, for instance, sepsis and necrotizing enterocolitis (University of South Florida, 2016). They children also have a lower rate of mortality, better visual development, reduced chronic diseases in old age, and higher scores of IQ. Moreover, it also promotes bonding between the infant and its parent, improves the health of the mother, and reduces the length of stay and costs of health care (University of South Florida, 2016).
However, often at times, the mother may have insufficient breast milk and alternative source of enteral nutrition have to be sought for such babies. These include breast milk from donors and artificial formulas (Quigley & McGuire, 2014). The donated breast milk may contain some amount of the non-nutritive benefits of the mother’s own milk for preterm or low birth weight babies. In addition, while artificial formulas may provide and ensure a consistent supply of nutrients at an optimal level, controversy exists regarding their impact on the child’s health (Quigley & McGuire, 2014). Uncertainty, therefore, exists about the risks and benefits of feeding such children donated milk from mothers and artificial formulas versus giving own mother’s milk for such children (Quigley & McGuire, 2014). This paper aims at highlighting the current problem that exists that is increased or continued use of donor milk and formula in the NICU for the very low birth weight babies. In addition, it will provide solutions to this existing problem.
- Background of the Study
Breast milk is considered to be the normal way of feeding infants that is globally accepted and also the optimal source of infant nutrition. The feeding of human milk that is milk from the baby’s own mother excluding that from donors during Neonatal Intensive Care Unit (NICU) stay brings down short and long term risks of infant morbidity (Meier, Engstrom, Patel, Jegier, & Bruns, 2010). It also reduces the risk of developing infections such as chronic lung infection (CLD), retinopathy, (ROP), nosocomial infections and neurocognitive delay among others including rehospitalization the following discharge from NICU (Meier, Engstrom, Patel, Jegier, & Bruns, 2010). The mechanisms of action provide the protective actions in various ways and also change over time during the stay in the NICU and are also specific to human milk components and not any other animal’s milk (Meier, Engstrom, Patel, Jegier, & Bruns, 2010). In addition, this human milk from the infant’s own mother can also not be replaced by any other commercial infant or donor milk from another human, and the feeding of own mother’s milk should be a priority for the NICU.
However, despite the fact that a majority of women intend to breastfeed their own infants, many of the mothers with sick and hospitalized infants have inadequate volumes of milk to provide the complete milk requirements for their children. This especially those that have very low birth weights as the women often suffer from numerous physical and emotional barriers that interfere with their breastfeeding abilities (Panczuk, Unger, O’Connor, & Lee). When the milk of the mother is unavailable, for such children who have the inadequate daily supply of milk, either pasteurized human donor milk is provided to them or alternatively a commercial milk formula is given either alone or together with the breast milk (Panczuk, Unger, O’Connor, & Lee).
Numerous studies have indicated that the interventions with donor breast milk and the milk formulas have reduced nutritional and immunological benefits compared to own mother’s milk. For instance, they have been found to have lower protein and energy content, they also have varying contents of the nutrients due to the manufacturing and treatment processes involved. Despite, these factors, there has been increased use of donated human milk and milk formulas in NICU a fact that has been attributed to the shortage of own mother’s milk. For instance, in 2013, only 47.5% of infants born with low birth weights in Florida’s NICUs received any form of own mother’s breast milk (University of South Florida, 2016). Due to the dangers of not receiving any milk, providing donated or artificial milk formulas, the uniqueness of own mother’s milk in terms of value, and the need by NICU to provide sufficient own mother’s milk several steps can be taken as highlighted below to address the issue.
- Statement of the Problem
As aforementioned, there has is an increased use of human donated milk and artificial nutritional formulas in NICUs in the country today. Human milk or own mother’s milk have nutritional value and components that cannot be found in any other animal’s milk or artificially prepared products. In addition, due to the processing (pasteurization) involved in preparing and preserving this human donated milk some of these beneficial values are lost. Moreover, these bowls of milk vary in content and, therefore, may not meet the physical and nutritional demands of the infants in NICUs. This, therefore, means that the preterm and low birth weight infants do not receive and adequate nutrients for growth and development and the development of a strong immune system.
These attempts to meet the shortage of own mother’s milk for infants using donated milk and artificial formulas have been found to be non-beneficial to the children. Hence, the need to find solutions to address this problem and meet the demand for own mother’s milk in NICUs. This paper, therefore, focuses on the disadvantages of using donated milk and artificial formulas and the possible solutions for addressing this problem by providing the possible solutions to the problem.
1.4. Purpose of the Study
The purpose of this study is to highlight the increased use of donor milk and formula in the NICU for the very low birth weight babies (< or = 1500 grams) due to the shortage of own mother’s milk. In addition, to highlight the possible solutions to increase production of own mother’s milk and the use of such milk in the NICUs.
1.5. Objectives of the Study
- To highlight the increased use of donor milk and formula in the NICU for the very low birth weight babies (< or = 1500 grams).
- To highlight the importance of using mother’s own milk in the NICU for the very low birth weight babies (< or = 1500 grams).
- To establish the possible solutions for using and promoting the use of mother’s own milk in the NICU for the very low birth weight babies (< or = 1500 grams).
1.6. Research Questions
- Is there increased use of donor milk and formula in the NICU for the very low birth weight babies (< or = 1500 grams)?
- What is the importance of using mother’s own milk in the NICU for the very low birth weight babies (< or = 1500 grams)?
- What are the possible solutions for using and promoting the use of mother’s own milk in the NICU for the very low birth weight babies (< or = 1500 grams)?
1.7. Significance of the Study
Research in this area will provide insight and understanding into why there is an increased use of human donated milk and milk formula in NICUs for the very low birth weight babies (< or = 1500 grams). It will also provide the much-needed knowledge regarding the importance of breastfeeding for mothers by highlighting the physical, nutritional and immunological value own mother’s breast milk has on the child hence add-on to already existing literature. Finally, it will also highlight the possible solution to the problem of increasing use of donated and artificial formulas among infants hence help NICUs deal with the current existing shortage of own mother’s milk and promote education and sensitization to using the same.
1.8. Limitation of the Study
The following limitations are expected:
- Resistance from participants in availing information.
- The extent of generalizability of the results.
- Research design.
1.9. Assumptions of the Study
The following are the assumptions of the study:
- All respondents will cooperate and provide reliable responses.
- Participants understand the concept of breastfeeding and the need to breast with own mother’s milk.
- The parents at the time of data collection will have an infant in the NICU or have had an infant in the NICU in the past.
CHAPTER TWO: LITERATURE REVIEW
2.1. Overview of Importance of Breast Feeding
Breastfeeding is considered to be the best nutritional source for all infants and exclusive breastfeeding is recommended by the WHO for at least six months. Breast milk has various functions that include the provision of protection from infections, autoimmune disease, dysfunctions of the gastrointestinal system, and the promotion of cognitive development (Hunter & Gottheil, 2012). This because it contains fats vital for the development of the brain, hormones and enzymes and, growth factors that are responsible for gastrointestinal development. It also contains antibodies and living cells for the prevention of infections and nutritious, sugars, fats, and proteins essential for the baby’s growth (Hunter & Gottheil, 2012). Therefore, virtually all children benefit from being breastfed regardless of their place of origin and residence because breast milk contains all the nutrients required by babies to remain healthy and grow in all dimensions of growth (Hunter & Gottheil, 2012). According to a study conducted by UNICEF in 2000, if every child globally would have been breastfed exclusively up to six months, approximately 1.5 million lives would be not only saved but also enhanced annually (Hunter & Gottheil, 2012). This is because mother’s own milk is considered to be the perfect food for babies during the first six months of their life with no artificial product matching it.
Premature infants in NICUs reconsidered being a heterogeneous group that has widely varying nutritional and immune protection requirements. If these are not met there is the risk for developmental delays, failure to grow, necrotizing enterocolitis, and on-set of sepsis later in life (Underwood, 2013). Therefore, breastfeeding should be the primary diet for such children. The recent policy statement of the American Academy of Pediatrics (AAP) regarding breastfeeding represents a significant shift from its early recommendation that human milk should be given together with donated milk to preterm children instead of a formula (Underwood, 2013). This where the mother cannot provide adequate breast milk.
Today, they recommend that mother’s own milk should be exclusively provided to the preterm babies and this is on the basis of an impressive array of benefits that human milk provides to this highly vulnerable population, including decreased rates of late-onset sepsis, necrotizing enterocolitis (NEC), and retinopathy of prematurity, fewer re-hospitalizations in the first year of life, and improved neurodevelopmental outcomes (Underwood, 2013). In addition, premature infants that receive human milk have lower rates of metabolic syndrome, lower blood pressure, and low-density lipoprotein levels, and less insulin and leptin resistance when they reach adolescence, compared to premature infants receiving formula.
2.2 The Problem of Increased Used of Donated Milk and Formulas
However, despite the importance of this mother’s own breast milk for the preterm low birth weight infant, not all mothers are able to provide adequate volumes of breast milk. This is due to several psychological and physical problems that these mothers experience before and after giving birth to their children (Underwood, 2013). This has resulted to into increased use of donated milk and milk formulas to meet the nutritional requirements of the infants in NICUs country wide.
However, the donated milk and the milk formulas have several disadvantages that render the ineffective in meeting the nutritional demands for the infant. This is due to several factors that include the process of pasteurization of the donated milk causes an alteration and/or reduction of the nutritional content of the breast milk (Quigley & McGuire, 2014). The process also affects the immunological element of the breast milk whereas the pasteurization process inactivates all the viruses and most bacteria, it also inactivates any beneficial immune cells present in the donated milk hence reducing its immunological properties.
Risks such as an acquisition of hospital acquired neonatal infections have been recorded and are tied to the way in which the donated milk is given. Infants have been found to develop bacterial infections following intake of milk from milk banks (Quigley & McGuire, 2014). For instance, a single outbreak of F. meningosepticum was found to come from one of the milk bottle stoppers, cleaned milk teats, and the environment. Other cases of deaths have been reported for children who received donated milk from single donors (Quigley & McGuire, 2014). Most of the infections found in children who had taken donated breast milk were those found from human skin’s normal flora. Similar dangers also exist for infants who use a formula in place of breast milk, For instance, such children have higher risks of infectious morbidity (Quigley & McGuire, 2014). In addition, they have a higher risk of developing cancers, they also have poor neurological and intelligence development, and also a poor immune system as the toxins in formulas interfere with their immunity.
2.3. Dealing with the Problem
Due to the ever increasing problems experienced by mothers at birth, there is an increased use of donated milk and milk formulas in NICUs for preterm babies. However, with the apparent negative consequences of these “emergency measures” to address the issue, there is the need for alternative solutions to address the problem. These are, for instance, increasing the production of Mother’s Own Milk combined with the increase the NICU’s usage of mother’s milk while decreasing the use of donor milk or formula and ensuring that the in-service staffs in NICUs understand the goal and the need to increase MOM and decrease donor and formula use. These can be attained by placing flyers/cards in the family/patient areas that provide the family with information regarding the importance of MOM.
Moreover, by place a TV in the family area as well as the mother’s room with power point/video answering the most asked questions. In addition, supplying the unit with the pumping logs to give the mother’s as well as placing extra logs at the patient’s bedside to remind the mother to document and keep track of their pumping. Among the staff, this can be attained by preparing the staff with the knowledge to answer questions mother’s may have regarding their pumping and/or production and placing posters and/or flyers in the staff areas in order to remind the staff of the MOM collaborative.
CHAPTER THREE: RESEARCH METHODOLOGY
This chapter describes the research design, study location, study population, sample size and sampling procedures, research instruments, data collection procedures, data analysis, and ethical considerations.
- Research Design.
The study will use a non-experimental approach and the descriptive survey design under this approach will be applied.
- Population of the study
The population of the study will include the staff working in the NICU, mothers with infants in NICU, and mothers that has children who went through the NICU.
3.3. Sampling size and Sampling procedures
The research will employ a non-probability convenient sampling procedure for all the three categories of the target population. However, apart from the staff, the sample for the mothers with infants in NICU and those with babies who went through the NICU and completed the treatment program will be determined by the following formula recommended by Israel (1982).
N = N
1 + N (e) 2
Where n is the sample size, N is the total population while e is the margin for error which is 0.051.
- Research instruments
The study will use questionnaires as its research instruments were both open and closed-ended questions will be included in these questionnaires. The questionnaires will be used because some of the questions asked are sensitive and therefore questionnaires will ensure confidentiality and also avoid victimization of the respondents where participants do not want to be identified.
The questionnaires will be researcher made and will contain closed-ended questions where respondents will be required to give a YES/NO answer and also open ended questions where a brief explanation of the respondent’s answer or additional information will be required.
- Data collection procedures
An introduction letter will be first sought from the university that will be used to seek permission from the Hospital’s administration to conduct the study at the Hospital. An authorization letter or permit will then be sought from the Hospital to allow commencement of the study. After the acquisition of these two documents, formal consent in the participation of the study will be sought out from the participants and on acquiring this consent the questionnaires will be administered to only those participants who have agreed to take part in the study for data collection.
- Data analysis
The data collected will be analyzed in various stages that are after collection the data will be edited and coded. The statistical descriptive analysis will then be carried out where the mean, mode, and standard deviation will be determined. The further inferential statistical analysis will be done on the data collected and the data will be prepared for presentation using tables and bar graphs.
A table of data analysis will also be prepared and will contain the research question, independent variable, dependent variable, and type of statistic.
- The participants have the right to give or not give information.
- The participants will have unconditional right to withdraw from the research at any time.
- The questionnaire presented to the participants shall have a cover letter explaining the intention and purpose of the study.
- The researchers will explain the purpose of the study to the participants in order for them to make an informed decision on whether to participate in the study or not.
- The participants will not be required to write their names on the questionnaires to ensure anonymity.
- The identities of the participants will be concealed to ensure confidentiality.
Hunter, C., & Gottheil, S. (2012). Breastfeeding & Promotion: The NICU Perspective. Health Promotions, Spring, 31-32.
Meier, P. P., Engstrom, J. L., Patel, A. L., Jegier, B. J., & Bruns, N. E. (2010). Improving the Use of Human Milk During and After the NICU Stay. Clin Perinatol., 37(1), 217–245.
Panczuk, J., Unger, S., O’Connor, D., & Lee, S. K. (n.d.). Human Donor Milk for the Vulnerable Infant: a Canadian Perspective.
Quigley, M., & McGuire, W. (2014). Formula versus Donor Breast Milk for Feeding Preterm or Low Birth Weight Infants. Cochrane Database of Systematic Reviews(4).
Underwood, M. A. (2013, February). Human Milk for the Premature Infant. Pediatr Clin North Am., 60(1), 189-207.
The university of South Florida. (2016). Mother’s Own Milk (MOM) Initiative. Retrieved July 11, 2016, from University of South Florida Website: http://health.usf.edu/publichealth/chiles/fpqc/mom