Banked human breast milk is used in some NICUs across the country. There are 4 main reason why it is not used for every preemie when his own mother’s milk is not available:
- Concerns about infection
- Lack of familiarity among NICU providers
Concerns about infection can be dismissed with simple education. There has never been a case of an infection transmitted by banked milk reported in the scientific literature in the United States (or anywhere else). Donors are screened and the milk is heat treated.
Logistics and lack of familiarity go hand in hand. There are currently 9 operating milk banks in the United States. Quite simply, it is easier to get milk for a baby in Colorado (especially if your baby is born at St. Luke’s, where the milk bank is located), than for a baby in Fargo. In addition, when the milk bank is in the same hospital, everyone is more familiar with the process. This also helps medical education, because doctor’s who train where banked milk isn’t available often fail to consider it as an option.
However, the biggest reason is cost, because that drives almost everything in health care. At almost $5 an ounce it is quite simply cost prohibitive. Or so it seems on the surface. Studies estimate that for every 14 premature babies (< 1,500 g at birth) fed banked milk, one case of necrotizing enterocolitis could be prevented. One case of NEC is an additional $200,000 a year for the first year (never mind subsequent years). In addition, there are studies to suggest that babies move faster from intravenous nutrition to milk, when banked milk is used instead of formula. Getting rid of IVs sooner also leads to less infections, also reducing cost of the NICU stay (never mind the expense of intravenous nutrition which requires a dedicated pharmacist and a nutritionist).
One would think there might be creative ways to lower the cost of banked milk. Women who donate milk could be given tax incentives or even a reduction in their own insurance premiums (we pay plasma donors, after all). The government (federal, state, or local) or even health insurance companies could donate physical space to lower overhead. Considering Medicaid is the single largest payor of NICU bills, one would think the government would have an invested interest in improving the availability of banked milk. Private insurers as well. Getting babies home sooner is simply better for every one.
Parents can also get involved. If breast milk isn’t an option, asking or even insisting on banked milk may help get the wheels moving at an NICU where formula is the standard. If your insurance doesn’t cover banked milk, talk with your human resources director and ask, “Why not?”
An additional 6 banks are developing, which is a start. But if the Red Cross can get blood to every hospital in the United States, surely there must be some way to get banked milk to every Level 3 NICU.