Jonat S, Koletzko B, Fewtrell MS, Embleton ND, van Goudoever JB, Gruszfeld D, Lapillonne A, McNulty A, Szitanyi P
Click on the image to read the standard in brief.
Target group
Preterm and ill term infants, and parents
User group
Healthcare professionals, neonatal units, hospitals, and health services
Statement of standard
Mothers are informed about the benefits of breastfeeding, encouraged and supported to provide their own breast milk for their infant. However, staff should be sensitive to maternal choice and avoid putting pressure on women who are unable to provide any or sufficient MOM or who choose not to do so.
Rationale
The promotion and provision of mother’s own milk (MOM) is a convincing strategy for reducing the risk of necrotising enterocolitis (NEC), sepsis and the associated costs, and improving brain, visual and cognitive development in preterm infants. (1–5) Evidence has accumulated that feeding fortified MOM achieves greater benefits that fortified donor human milk. (6–9)
Although the use of feeding MOM to preterm infants has increased over the last decade, breast-pump dependant mothers of preterm infants face specific barriers to the initiation and maintenance of sufficient lactation. (10) Similarly, term infants benefit from the provision of MOM. Implementation of multidisciplinary lactation teams for education and advocacy of healthcare professionals, mothers and families as well as accessible milk pumps, and sufficient technology for pasteurisation and storage improve milk volume, infant nutrition and might lead to improved health measures in very low birth weight (VLBW) infants. (11,12)
Unfortified human milk does not fully provide for the unique nutritional needs of the very preterm infant. Fortification of MOM improves protein-to-energy and mineral-to-protein ratios, and micronutrient supply. (13,14) The recommended supply of docosahexaenoic acid (DHA) for very low birth weight infants can be met through MOM if mothers take a high dose DHA supplement. (15,16)
Benefits
Short-term benefits
Reduced prematurity related morbidity (less feeding intolerance, decreased risk of serious morbidity, i.e. NEC and sepsis) (1–3)
Reduced healthcare costs (2,3)
Long-term benefits
Improved neurodevelopmental outcomes (4,5)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents are informed by healthcare professionals about the benefits of mother’s own milk (MOM) and encouraged and supported to provide MOM (see Care procedures).
A (Low quality) B (High quality)
Guideline, patient information sheet1*
For healthcare professionals
A unit guideline on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation and its appropriate documentation, is adhered to by all healthcare professionals.
B (High quality)
Guideline
Training on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation, is attended by all responsible healthcare professionals (see Care procedures).
B (High quality)
Training documentation
For neonatal unit
A unit guideline on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation and its appropriate documentation, is available and regularly updated.
B (High quality)
Audit report2, clinical records, guideline
Multidisciplinary infant nutrition and lactation teams to provide education and advocacy for MOM provision are available.
A (Low quality)
Audit report2
Timely access to effective and efficient breast pumps, containers, pump kits and breast shields for mothers of preterm infants is provided.
A (Low quality)
Audit report2, guideline, parent feedback
For hospital
Training on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation, is ensured.
B (High quality)
Training documentation
Sufficient resources (staff (nurses, lactation specialists, dieticians, doctors), equipment including fridges and freezers, pasteurisers, and space for milk expression) are provided.
A (Low quality) B (High quality)
Audit report2
For health service
A national guideline on infant nutrition, including the importance and provision of MOM, fortification, and supplementation is available and regularly updated.
B (High quality)
Guideline
¹The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator “audit report” can also be defined as a benchmarking report.
*The TEG Nutrition very much supports the need of good communication with families and regular sharing of key information, but it is not in favour of sharing information on each standard by a “parent information sheet”, which is the term chosen by the Chair Committee. In our view, sharing multiple parent information sheets bears the risk of overloading families with a plethora of written information during a stressful time period, which may not be very helpful. We suggest to consider other means of sharing information.
Where to go
Further development
Grading of evidence
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
Review the impact of the bundle of measures on the ratio of fully or partially breastfeed infants and MOM availability at discharge, respectively.
A (Low quality)
For hospital
Review impact of establishing and increasing human milk usage and potential cost saving from decreased use of parenteral nutrition.
A (Low quality)
For health service
N/A
Getting started
Initial steps
For parents and family
Parents are verbally informed by healthcare professionals about the benefits of mother’s own milk (MOM) during pregnancy and after delivery.
For healthcare professionals
Attend training on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation without pressurising mothers who are unable to provide their own milk or who choose not to do so.
For neonatal unit
Develop and implement a unit guideline on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation and its appropriate documentation (e.g. (11)).
Develop information material on the importance and provision of MOM as well as the initiation of lactation for parents.
For hospital
Support healthcare professionals to participate in training on infant nutrition, including the importance and provision of MOM as well as the initiation and maintenance of lactation.
Provide facilities and equipment for milk expression.
For health service
Develop and implement a national guideline on infant nutrition, including the importance and provision of MOM, fortification, and supplementation.
The use of mother’s own milk (MOM) for preterm and ill term infants should be encouraged. Special emphasis should be placed on the early lactation period during the first two weeks after delivery when the mammary gland transits from secretory differentiation to secretory activation. Special guidance of the lactating mother with regard to pumping strategies to facilitate breastfeeding should be implemented in the daily routine on the NICU. Mothers should also be informed about the physiology of lactation to set their expectations; in particular they need to understand the importance of small amounts of colostrum (see Care procedures) and that they should not expect to express large volumes of milk in the early days. Protocols for the safe handling are helpful to preserve the high quality of mother’s own milk. Fortification of own mother’s milk and nutrient supplementation of the lactating mother will further improve the nutritional value of MOM for the preterm infant.
Corpeleijn WE, Kouwenhoven SMP, Paap MC, van Vliet I, Scheerder I, Muizer Y, et al. Intake of own mother’s milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology. 2012;102(4):276–81.
Patel AL, Johnson TJ, Engstrom JL, Fogg LF, Jegier BJ, Bigger HR, et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol Off J Calif Perinat Assoc. 2013 Jul;33(7):514–9.
Patel AL, Johnson TJ, Robin B, Bigger HR, Buchanan A, Christian E, et al. Influence of own mother’s milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed. 2017 May;102(3):F256–61.
Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Higgins RD, Langer JC, et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007 Oct;120(4):e953-959.
Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Wright LL, Langer JC, et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006 Jul;118(1):e115-123.
Valverde R, Dinerstein NA, Vain N. Mother’s Own Milk and Donor Milk. World Rev Nutr Diet. 2021;122:212–24.
Madore LS, Sen S. Inconsistencies in Outcomes of Donor Breast Milk for Preterm Infants. Clin Ther. 2017 Dec;39(12):2451–2.
Brownell EA, Matson AP, Smith KC, Moore JE, Esposito PA, Lussier MM, et al. Dose-response Relationship Between Donor Human Milk, Mother’s Own Milk, Preterm Formula, and Neonatal Growth Outcomes. J Pediatr Gastroenterol Nutr. 2018 Jul;67(1):90–6.
Wu T, Jiang P, Luo P, Chen Y, Liu X, Jiang Y, et al. Availability of donor milk improves enteral feeding but has limited effect on body growth of infants with very‐low birthweight: Data from a historic cohort study. Matern Child Nutr. 2022 Jan 18;18(2):e13319.
Meier PP, Johnson TJ, Patel AL, Rossman B. Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants: An Expert Review. Clin Perinatol. 2017 Mar;44(1):1–22.
Bixby C, Baker-Fox C, Deming C, Dhar V, Steele C. A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant. Breastfeed Med Off J Acad Breastfeed Med. 2016 Mar;11(2):75–9.
Lee HC, Kurtin PS, Wight NE, Chance K, Cucinotta-Fobes T, Hanson-Timpson TA, et al. A Quality Improvement Project to Increase Breast Milk Use in Very Low Birth Weight Infants. PEDIATRICS. 2012 Dec 1;130(6):e1679–87.
Picaud JC, Vincent M, Buffin R. Human Milk Fortification for Preterm Infants: A Review. World Rev Nutr Diet. 2021;122:225–47.
Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. Front Nutr. 2017;4:20.
Koletzko B. Human Milk Lipids. Ann Nutr Metab. 2016;69 Suppl 2:28–40.
Koletzko B, Lapillonne A. Lipid Requirements of Preterm Infants. World Rev Nutr Diet. 2021;122:89–102.
September 2022/ 2nd edition / previous edition reviewed by Berns M / next revision: 2025
Recommended citation
EFCNI, Jonat S, Koletzko B et al., European Standards of Care for Newborn Health: Providing mother’s own milk (MOM) for preterm and ill term infants. 2022.
