Survey of enteral feeding of preterm infants and the human milk bank in Japan

Abstract

BackgroundIn Japan, the first human milk bank (HMB) was established in 2017, which changed the practice of enteral feeding in neonatal care. This study investigated the practice of enteral feeding of preterm infants after the establishment of the HMB in Japan and examined related future issues.MethodsA survey on enteral feeding and the use of the HMB was conducted in 251 neonatal intensive care units (NICUs) from December 2020 to February 2021.ResultsThe response rate was 61%. The ideal times to start enteral feeding for extremely‐low‐birthweight infants (ELBWI) and very‐low‐birthweight infants (VLBWI) were within 24 h after birth in approximately 59% and 62% of NICUs, however, only 30% and 46% could do so, respectively. Artificial nutrition was used to initiate enteral feeding for ELBWIs and VLBWIs in in 24% and 56% of NICUs, respectively. Of the NICUs, 92% considered the HMB “necessary” or “rather necessary”. Fifty‐five percent wanted to use the HMB but could not. The major reasons for this were (1) difficulty in paying the annual membership fee, (2) difficulty obtaining approval from the NICU, and (3) complexity in using the facility. The indications for using and discontinuation of use of donor milk varied among the NICUs. Only in 17%, milk expression was within 1h after delivery.ConclusionsCompared with before the establishment of the HMB, NICUs are currently more willing to start enteral feeding for preterm infants earlier. However, the implementation of enteral feeding appears to be challenging. Issues related to the HMB highlighted by the responses need to be addressed. Additionally, guidelines for using donor milk should be established.

Questionnaire survey on donor human milk programs targeting NICUs in Japan

“…In this current study, the NICUs that had access to HMB replied that the ideal starting time for EN for ELBW infants was within 12 (58.3%) and 24 h (41.7%) after birth. The percentage of NICUs that start EN within 24 h was 30% in all NICUs 8 on the 2020 study and 50% in this study. In other words, NICUs that have access to HMB not only plan to start EN but also start EN as they desire.…”

“…In 2020, we conducted a questionnaire survey of all the NICUs that are members of the Japanese Neonatologist Association. The results showed that the ideal starting time for EN for ELBW infants was within 12 and 24 h after the birth of 18% and 58% NICUs, respectively 8 . In this current study, the NICUs that had access to HMB replied that the ideal starting time for EN for ELBW infants was within 12 (58.3%) and 24 h (41.7%) after birth.…”

“…The results showed that the ideal starting time for EN for ELBW infants was within 12 and 24 h after the birth 18% and 58% NICUs, respectively. 8 In this current study, the NICUs that had access to HMB replied that the ideal starting time for EN for ELBW infants was within 12 (58.3%) and 24 h (41.7%) after birth. The percentage of NICUs that start EN within 24 h was 30% in all NICUs 8 on the 2020 study and 50% in this study.…”

“…A questionnaire survey conducted in 2020 by the Health and Labor Sciences Research Grants research group found that 91% of 154 NICUs acknowledged the need for human milk banks (HMB). 8 Additionally, nearly 70% of the facilities that did not currently use DHM indicated an interest in using it in future. The results of this survey also revealed that the reasons for not using the HMB were the time and effort required to obtain facility approval (e.g., ethics review) and the cost of DHM.…”

“…A questionnaire survey conducted in 2020 by the Health and Labor Sciences Research Grants research group found that 91% of 154 NICUs acknowledged the need for human milk banks (HMB) 8 . Additionally, nearly 70% of the facilities that did not currently use DHM indicated an interest in using it in future.…”