Breast Milk Misappropriation: Prevention and Mitigation

The Amplified Benefits of Breast Milk for NICU Infants

Breast milk is a well-established source of nutrition for all infants, but its benefits are particularly amplified for premature or critically ill infants in a Neonatal Intensive Care Unit (NICU).

Evolution of Breast Milk Collection and Storage

Over the past several decades, the methods of breast milk collection and storage have evolved significantly. With advancements in neonatal critical care and the integration of digital platforms, what once involved simple freezer storage has transformed into a sophisticated system. Today, breast milk is collected in containers labeled with barcodes and integrated with electronic medical records (EMR).

Preventing Errors in Breast Milk Administration

Given the frequency of breast milk feedings in NICUs, there are numerous opportunities for error. Issues such as staff inattention, improper bin placement, illegible labels, and scanner malfunctions can lead to a neonate receiving milk from an incorrect source. To mitigate these risks, implementing a breast milk management system and milk bank is crucial for safe practice.

The 5 Rights of Breast Milk Administration

To prevent errors, the following "5 Rights" must be adhered to before feeding:

1. Right Patient: Verify patient ID band and medical record number with the feeding order.

2. Right Milk: Ensure the breast milk bottle label matches the patient ID band.

3. Right Dose: Confirm breast milk concentration and volume with the feeding order.

4. Right Route: Verify the feeding method (e.g., PO, NG, GT) with the order.

5. Right Time: Check that the breast milk is not expired and aligns with the feeding schedule.

Addressing Breast Milk Misappropriation

While not widely reported, misappropriation of breast milk can occur in NICUs, potentially leading to the transmission of infectious diseases like CMV, HIV, or Hepatitis B. Such errors can also result in emotional distress for families and increased testing costs. Hospitals must have policies in place to address these errors, maintaining confidentiality and ensuring proper communication and testing protocols.

Steps for Handling Breast Milk Misappropriation

1. Maintain confidentiality for both donor and recipient mothers.

2. Disclose the misappropriation to both mothers separately.

3. Review donor mother's prenatal lab results before informing the recipient mother.

4. Consider aspirating the infant's stomach contents if necessary.

5. Notify the department of epidemiology and infection control.

6. Test the donor mother for HIV, Hepatitis B, and Hepatitis C, or test the recipient infant if the donor refuses.

7. Notify risk management and the hospital lactation coordinator.

8. Document the exposure and any refusals for testing in the medical record.

Conclusion

Breast milk misappropriation is a stressful event with potential harm. Implementing robust systems to ensure safe practices is essential. Despite significant advancements in labeling systems and milk banks, continued efforts are necessary to prevent such occurrences.

References

• Hartmann, B. (2017). Ensuring Safety in Donor Human Milk Banking in Neonatal Intensive Care. Clinics in Perinatology, 44, 131-149.

• DeMarchis, A., Israel-Ballard, K., Manson, K., Engmann, C. (2017). Establishing an Integrated Human Milk Banking Approach to Strengthen Newborn Care. Journal of Perinatology, 37, 469-474.

• Reimers, P., Coutsoudis, A. (2021). Donor Human Milk Banking-Time to Redirect the Focus. Journal of Human Lactation, 37(1), 71-75.