Feeding practices among vulnerable newborns in Vietnam: a pre- and post-evaluation of integrating a human milk bank into newborn care services
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Introduction: Infant feeding practices and lactation support when mother’s own milk is unavailable, especially among vulnerable infants in neonate intensive care unit situations (i.e. pre-term, low birthweight) are not well understood globally. Integration of human milk banking services and provision of donor human milk as early essential newborn care may offer the support and resources necessary to achieve optimal infant feeding practices. Previous studies suggest improved breastfeeding rates at discharge with the introduction of an integrated human milk banking program, however this finding has not been well characterized. An impact evaluation is underway to investigate changes in infant feeding practices to increase safe use of human milk from before and after integration of a human milk bank at the Da Nang Hospital for Women and Children in Da Nang, Vietnam. Methods: A pretest and posttest evaluation was conducted surrounding the opening of the human milk bank at the Da Nang Hospital for Women and Children in Da Nang, Vietnam, a WHO-designated Center of Excellence for early essential newborn care. All infants admitted to the neonatal ward on day one of life were included and 14 days of data collection took place on volumes, routes, and types of feed for each infant until discharge or death. Outcomes of interest were exclusive quality-controlled human milk feeding, any exposure to formula, and any exposure to another mother’s milk. Chi-squared tests and the Mantel-Haenszel method were used to investigate the associations between exposure to the milk bank and each outcome of interest. Results: The proportion of infants fed exclusive quality-controlled human milk was significantly higher in the posttest group relative to the pretest group on all 14 days of the study; posttest exclusive quality-controlled human milk feeding was 100% at day 1 and reduced steadily through follow-up to 65% by day 14, while pretest was 4% at day 1 and reached 0% by day 9 (all 2 p<0.001). The proportion of infants exposed to formula was significantly lower in the posttest group than the pretest group during the first seven days of data collection (all 2 p<0.05) and was similar thereafter; posttest exposure to formula was between 0% and 4% throughout follow-up while pretest exposure to formula was 36% at day 1 and reduced to 4% by day 8. The proportion of infants exposed to another mother’s milk was significantly lower in the posttest group compared to the pretest group through day 10 (all 2 p<0.001); posttest exposure to another mother's milk was between 0 and 3% throughout follow-up, while pretest exposure to another mother's milk was 73% at day 1 and reduced throughout follow-up to 4% by day 14. Conclusion: Results of this study suggest a positive impact of the integration of a human milk bank into newborn care services in Vietnam, specifically for an increase in the uptake of quality-controlled human milk and decreases in exposure to formula and another mother’s milk. This study informs future models for integrating human milk banking into health systems in Vietnam. Further research to determine the best practices for the provision of donor human milk, as well as improved data collection and better alignment of global nutrition policies are all necessary to achieve equitable access to human milk for vulnerable infants.
- Epidemiology