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Procurement and use of pasteurized donor human milk in the outpatient setting: retrospective analysis and case study

Hayden-Vázquez, Paula (2024) Procurement and use of pasteurized donor human milk in the outpatient setting: retrospective analysis and case study. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background/Significance: Due to the importance of human milk for infant health, organizations including the American Academy of Pediatrics recommend the use of pasteurized donor human milk (PDHM) if parents’ milk supply is unavailable for low birthweight infants. PDHM, like parental milk, contains macro- and micronutrients and other factors (hormones, immune components) that are essential for infant growth, development, and optimal physiologic functioning. Human milk banks screen and pasteurize raw, donated milk from milk donors to ensure safety and preserve nutritional quality. The use of PDHM has been linked to the reduction of serious neonate conditions, such as necrotizing enterocolitis (NEC). For this reason, hospitalized infants with critical illness and/or prematurity who are at risk of NEC, have been prioritized for PDHM, with infrastructure to support cost coverage. Outpatient PDHM use for other infants with medical conditions who could potentially benefit from PDHM is constrained by the associated costs of procurement and processing and insurance coverage barriers, but there is a growing interest in PDHM beyond the hospital setting. Infants discharged from pediatric hospital settings often have ongoing serious health issues and could benefit from continued PDHM until they can transition to human milk substitutes (e.g., commercial infant formula) or solid foods. Currently, patterns of procurement and distribution of PDHM and familial experiences with PDHM in the outpatient setting are understudied.

Purpose: To describe patterns and experiences with outpatient PDHM distribution/use, including indications for dispensation, cost coverage, volumes, periods of use, and perceived value and barriers to use and procurement.
Methods: This study was a retrospective analysis conducted on de-identified data from infants receiving outpatient PDHM provided by a single milk bank over a period of 5 years. In addition, we interviewed and reviewed health records of a mother whose infant had received outpatient PDHM as a case study. For the retrospective analysis, summary statistics were computed.

Results: The analytic sample for the retrospective analysis included 423 infants who received outpatient PDHM from the milk bank. On average, outpatient PDHM was dispensed for under a month (n=57; 42%) with most families not having any of the costs covered by insurance. Families paid a mean of $1,571 for outpatient PDHM (SD: $4,386, Range: $0- $49,515). The most common type of PDHM prescribed was term infant milk (n=400; mean=23,970 mL) followed by dairy-free milk (n=42; mean=43,646 mL) and low dairy milk (n=26; mean=9,627 mL). The case study illustrated that there was poor awareness of outpatient PDHM as an infant feeding within the healthcare community, and that a major barrier to the procurement of outpatient PDHM was advocating for and coordinating insurance coverage. The case study highlighted that a high level of organization and commitment was needed from the parent to obtain insurance approval and that there were significant delays in obtaining the milk. The case study highlighted the financial and time costs that accessing outpatient PDHM places on the recipient family.

Conclusion: PDHM is a lifesaving intervention that can be critical to infant/child health in the inpatient setting, with limited current evidence to support use in outpatient settings. However, families who access and utilize PDHM in the outpatient setting with a $1,500 average cost for a month’s supply of PDHM access are largely limited to those who have high incomes, private insurance that covers PDHM, or residents of Pennsylvania under the Medicaid program. Finally, there are a lack of federal public healthcare programs and policies that enable access to PDHM on an outpatient basis. Further research needs to be conducted into the benefits of and access to outpatient PDHM use in different racial, ethnic, and socioeconomic groups.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hayden-Vázquez, Paulapah94@pitt.eduPAH940009-0004-9068-6065
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorDemirci,
Committee MemberPerrin,
Committee MemberMaurer,
Committee MemberKloesz,
Date: 23 April 2024
Date Type: Publication
Defense Date: 11 April 2024
Approval Date: 23 April 2024
Submission Date: 15 April 2024
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 48
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: milk banks, HMBANA, Human Milk Banking Associate of North America, MAMMB, Mid-Atlantic Mother's Milk Bank
Date Deposited: 23 Apr 2024 14:59
Last Modified: 23 Apr 2024 14:59

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