Survey of a nutrition management method for very low birthweight infants: Status before wide use of breast milk banks in Japan

Abstract

Background The importance of breast‐feeding for very low birthweight (VLBW) infants has been pointed out. Some overseas studies suggested that the standardization of enteral nutrition (EN) leads to improved prognosis in VLBW infants. In Japan, however, physicians in charge of infants are responsible for making nutrition management decisions on an individual basis. We conducted an online survey to clarify the course of nutrition management of VLBW infants currently implemented in Japan. Methods We mailed a notice to 300 representative neonatologists throughout Japan requesting their participation in the online survey. On the survey website, neonatologists responded to questions regarding the nutritional strategy for five birthweight groups (less than 500 g, 500–749 g, 750–999 g, 1,000–1,249 g and 1,250–1,499 g). Results Responses were recieved from 137 neonatologists. The first choice for EN up to 1 week after birth was breast milk regardless of birthweight (92.0% for 1,250–1,499 g to 95.6% for 500–999 g). More than 30% of the respondents answered that they fast infants who weigh <750 g at birth or feed them with other mothers’ breast milk until their own mother’s milk becomes available. The lower the birthweight, the later EN is started, and the greater the number of days to establish EN. Conclusion The lower the birthweight, the more difficult it is to feed infants their own mother’s milk and the later the EN is started. If donor milk is supplied in a stable manner, it takes fewer days to establish EN.

Questionnaire survey on donor human milk programs targeting NICUs in Japan

“…Half of the respondents reported that EN initiation was standardized at their NICUs, while the other half reported that EN was initiated at the discretion of the attending physician. In a previous survey, 35% of the respondents answered that EN was standardized; therefore, NICUs that have access to HMBs may have a higher rate of standardization 14 . The benefits of standardizing EN, as discussed previously, are expected to spread in Japan, considering that the use of DHM has increased over the years 15 …”

Experience using donor human milk: A single‐center cohort study in Japan

“…In fact, these optimal effects of early EN initiation were not observed in non‐ELBW infants, who typically received EN with DHM or infant formula without waiting for MOM to become available, before and after the introduction of DHM. This protocol regarding EN initiation in ELBW infants appears identical to that used in other NICUs in Japan, 6 so DHM may be useful for early EN initiation and achievement in ELBW infants.…”

“…Several international organizations and academic societies recommend the use of donor human milk (DHM) in premature infants when MOM is not available [3][4][5] ; however, there were previously no accredited human milk banks in Japan. Therefore, the fasting period was prolonged or artificial milk was occasionally used instead of breast milk, which resulted in delayed establishment of enteral nutrition (EN) 6 .…”

Impact of time to full enteral feeding on long-term neurodevelopment without mediating by postnatal growth failure in very-low-birth-weight-infants

“…TFF is inextricably related to immaturity and related illnesses, including short-term morbidities, and is thus regarded as an index of the clinical course for VLBW infants during NICU stay. Nonetheless, there are significant variations in clinical practice 50 concerning determination of TFF, such as when the enteral feeds were initiated 51 , 52 , how fast they advanced 9 , 44 , 45 , 53 , 54 types of milk that were provided 55 , 56 , and how feeding intolerance was managed by the medical staff 57 in each unit. Therefore, compelling evidence on the positive impact of early TFF during NICU stay on long-term neurodevelopmental outcomes, which is independent of and not mediated by long-term growth, would provide an important rationale for quality improvement strategies targeting early TFF in VLBW infants during neonatal intensive care.…”