Factors Associated with the Prolonged Use of Donor Human Milk at the Da Nang Hospital for Women and Children in Vietnam

Abstract

Background and objectives: Donor human milk (DHM) from a human milk bank (HMB) is used to feed low-birthweight (LBW) and preterm infants when mothers cannot provide their own breastmilk. The misuse of DHM could interfere with mothers' breastmilk and weaken breastfeeding efforts. This study aimed to identify factors behind prolonged DHM usage during the first six years of Vietnam's first HMB.

Methods: Data were extracted from the Da Nang HMB's digital monitoring system. We defined prolonged DHM use as four or more days in the neonatal unit and two or more days in postnatal wards.

Results: Over six years, 25,420 infants received DHM, with 45.3% of the infants being female, 54.7% being male, 70.0% being born via cesarean section, and 77.2% being full-term. In the neonatal unit (n = 7001), 38.0% of infants used DHM for ≥4 days. Adjusted odds ratios (aORs) for prolonged use were 0.14 for infants weighing <1000 g, 0.78 for infants weighing 1000-<1500 g, and 0.67 for infants weighing ≥2000 g (p < 0.01), compared to those weighing 1500-<2000 g. Compared to gestational ages of 32-<34 weeks, the aORs were 0.26 for <28 weeks, 0.71 for 34-<37 weeks, and 0.35 for ≥37 weeks (p < 0.01). In postnatal wards (n = 18,419), 53.1% of infants used DHM for ≥2 days. Compared to term, normal-weight infants, the aORs were 1.25 for LBW-preterm, 1.17 for LBW-term, and 1.21 for normal-weight-preterm infants (p < 0.05). Prolonged DHM use was associated with cesarean births in neonatal units (aOR 2.24, p < 0.01) and postnatal wards (aOR 1.44, p < 0.01).

Conclusions: DHM is used briefly to bridge nutritional gaps and transition to mothers' breastmilk, but LBW, preterm births, and cesarean births are linked to prolonged use. Healthcare providers should support those at risk of prolonged DHM use and prioritize reducing unnecessary cesarean births.

Keywords: breastfeeding; cesarean births; donor milk; human milk bank; infant; low birthweight; preterm births.

Figure 1

Distribution (%) of duration of use of DHM (days) in neonatal units (A) and postnatal wards (B) by year.

Figure 2

Adjusted ORs of prolonged DHM use in neonatal unit for birth weight categories (A) and gestation age (B) and postnatal wards for birth weight and gestational age categories (C). All models controlled for child sex, mothers from other provinces, cesarean births, and births before 2020; the model in panel A controlled for gestational age in a continuous form; and the model in panel A controlled for birth weight in a continuous form.