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Medical community seeks to increase use of donor breast milk in Maryland

LaQuasha Singletary was having a normal pregnancy until the day her blood pressure shot up and her vision blurred.

The Pikesville woman was rushed to Sinai Hospital, where she delivered a 2-pound, 8-ounce baby boy named Caleb Lyles 10 weeks sooner than expected.

Caleb's early delivery left him vulnerable to necrotizing intestinal disorder, a potentially deadly disease common in premature babies whose digestive systems aren't fully developed. Studies show feeding with breast milk exclusively reduces babies chances of getting the disease.

Singletary, 23, was able to breast-feed Caleb, but he also needed a special fortifier made from donated breast milk that contains nutrients premature babies require. Since Sinai is one of the state's few hospitals licensed to bank donated breast milk, she didn't have to use a fortifier made with less than ideal formula. The bank also provides milk to babies of mothers who can't breast-feed.

Sinai, which opened its milk bank in May, is part of a growing movement in the Maryland health community to make breast milk donated by other mothers more available in hospitals. So far only three hospitals — Sinai, Johns Hopkins and Saint Agnes — are licensed by the state to use donated milk.

In 2010, Maryland hospitals provided donor milk to just nine babies. A state legislative work group recently presented recommendations to the General Assembly on ways to increase those numbers.

Supporters of its use say donor milk can help save dozens of babies' lives.

"Very premature babies are at risk for a lot of problems," said Dr. Carolyn B. Moloney, attending neonatologist at Saint Agnes. "Babies who get their mother's milk or donor milk lower their risk."

Necrotizing intestinal disorder is the most common life-threatening disease in babies born early, developing in 10 percent of infants weighing less than about 3 pounds. In Maryland, 499 infants developed the disease from 2005 to 2009 and 79 died from it, according to findings by the work group.

The disease develops when the lining of the intestinal wall dies and the tissue falls off. The worst cases leave a hole in the baby's bowel, which can cause waste to leak into the body. Babies who don't die from the disease may develop lifetime complications.

It is not known what causes the disease, but theories point to bad bacteria as a culprit. Decreased blood flow to the bowel also may prevent the formation of protective mucus in the gastrointestinal tract.

Various studies, including one by Johns Hopkins in 2010, have found the nutrients and growth factors in breast milk help fight off the disease, reducing a baby's chances of contracting it.

But not all women can breast-feed. Some mothers aren't far enough along in their pregnancy for their milk to have come in. Stress may make it hard for others to breast-feed, or they may have a medical condition that prevents it.

Donor milk programs have been slow to catch on in Maryland. Hopkins used it as part of a three-year study beginning in 2008 and received a permanent license last year. Saint Agnes was one of the early adopters, starting its program in 2008.

Supporters cite varying reasons for hospitals' lack of interest. Some hospitals may perceive the state regulatory process as burdensome. Maryland classifies human milk as a tissue, as it does blood products, and requires a special license for its use. Other states classify donor milk as a pharmaceutical or nutritional product. Donor milk programs must be inspected and follow a set of quality controls. The rules help keep milk safe, but may seem tedious to hospitals.

Others said hospitals just don't know enough about the practice and may worry about the expense. It costs about $1,500 to feed the average baby with donor milk, according to a state report.

Supporters of donor milk say its use cuts down on a baby's length of stay in a neonatal intensive care unit, saving money in the long term. They also see it as a form of preventive care. It's much more costly to treat necrotizing intestinal disorder.

Thomas O'Brien, medical director of newborn services at Sinai, said it wasn't hard to sell the idea to hospital executives once they were told the benefits. Officials there realized starting a milk program "was the best thing we could do for our patients," O'Brien said.

Sometimes it's the mothers that need convincing. Some may be reluctant at first to use milk from another woman because of what doctors and nurses call the "ick" factor.

"Some people are a little squeamish about it," Moloney said.

Moloney and others said donor milk is safe.

Donor milk comes from banks around the country monitored by the Human Milk Banking Association of North America. The banks have to meet certain criteria to ensure the milk's safety. Mothers who donate are not paid and are screened for risk factors such as drug use and infectious diseases, including HIV and hepatitis. The milk is pasteurized.

Singletary said she wasn't sold on the idea at first because she was unsure about the risks. But she also believed firmly that breast milk was better than formula and felt more comfortable about the idea after speaking with her doctor.

"Because he was a preemie, I especially wanted to make sure that he got all the nutrients I could give him," Singletary said.

Caleb never developed NEC and, at 2 months old, had grown to more than six pounds.

The state work group was established last year after Baltimore County Del. Shirley Nathan-Pulliam introduced legislation to require Medicaid coverage of donor milk for premature babies in intensive care. Legislators thought it was better to study the issue first.

The work group decided against pushing for legislation but included several recommendations in its final report to lawmakers on how to increase the use of donor milk. The group suggested adding the use of banked milk in the Maryland Perinatal System Standards, a set of voluntary standards for Maryland hospitals that provide obstetrical and neonatal services. It also suggested meeting with the state regulators to possibly simplify the steps to manage a donor milk bank.

"I think this is an ongoing process," said Julie Murphy, a neonatal lactation specialist at Johns Hopkins who was part of the work group. "Some institutions are ahead of others, but there is a general awareness and we're working to do more."



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