15 Introduction

Paula P. Meier, Prof, PhD, RN, FAAN

Whereas human milk is important to every infant’s health, there are specific circumstances, like premature birth, where the absence of a mother’s milk is particularly detrimental to the health of the infant. The chapters in Part III (see Chapters 16 to 20) summarise the evidence, best practices and research priorities for three such circumstances, as well as the use of pasteurised donor human milk as a supplement or alternative. These chapters reiterate a common theme – the importance of basing the decision to feed an infant with mother’s milk on available evidence, instead of adopting a default stance of “being on the safe side with pasteurised donor human milk or formula.”

The section provides evidence about how the unique nutritional and bioactive components of a mother’s milk cannot be replaced by donor human milk for multiple reasons, including those linked to pasteurisation and storage processes. Furthermore, it outlines evidence that formula – especially for premature infants during the early post-birth period – is in fact detrimental. Research shows formula in these circumstances may result in short- and long-term health complications due to its inflammation-inducing properties and its negative impact on early nutritional programming. Thus, it supports the concept that the decision to advise a mother on how to feed a premature infant (in the case of a neonatal intensive care unit, or Neonatal Intensive Care Unit [NICU], infant) should be individualized and situation-specific, with the indisputable knowledge that the benefits for the neonate of receiving own mother’s milk greatly outweigh the risks.

Part III (see Chapter 16) begins with a chapter written by myself and members of my team, Dr Beverly Rossman, Dr Aloka L. Patel, Dr Tricia J. Johnson, Dr Janet L. Engstrom, Dr Rebecca A. Hoban, Dr Kousiki Patra, and Dr Harold R. Bigger, all experts in the use of human milk in NICU. Each offers real-life examples and recommendations of how to ensure these high-risk infants benefit from the life-giving properties of human milk. This is complemented by chapter 17, providing summary interviews with well-respected human milk banking experts. It provides on-the-ground insight into approaches that ensure infants receive as much of their own mothers’ milk as possible, rather than compromised outcomes following rushed decisions for donor human milk use. Each strategy highlights the need for specialists with combined expertise in lactation processes, human milk science and pediatric care (including neonatology for NICU).

This is followed by Dr Lukas Christen (see chapter 18), a researcher in the Hartmann Human Lactation Research Group, who then addresses the promising alternatives to current methods of pasteurisation that eradicate pathogenic bacteria and improve storage options for donor human milk now being studied.

Next is a chapter on a subject that has received considerable attention in the last decade: breastfeeding when mothers are human immunodeficiency virus (HIV) positive (see chapter 19). Professor Anna Coutsodis, a Professor of Paediatrics and Child Health at the University of KwaZulu-Natal, discusses the risks, options and latest recommendations from professionals in the field.

Part III concludes with a chapter (see Chapter 20) from Professor Tom Hale, a Professor of Paediatrics and Associate Dean of Research, and Dr Teresa Ellen Baker, MD, FACOG, both at the Texas Tech University Health Sciences Center School of Medicine, that takes a closer look at the various aspects of breastfeeding in situations where the mother requires medication. While all medications transfer to human milk to some degree, risks vary according to the class of drug. Most drugs have little to no effect on infants. Others, however, do present risks clinicians and mothers should be aware of. This chapter looks at these classes and the risk/benefit analyses that must be conducted to ensure optimal health for both infants and mothers. It provides information about measuring infant exposure to certain medications, and covers considerations and recommendations for those clinicians prescribing medication to lactating women. Finally, the authors present details about where to find further help and advice.