A comprehensive clinical report in Pediatrics\u00a0<\/em>has issued a call to action to promote human milk for vulnerable very-low-birthweight (VLBW) newborns weighing \u2264 1500 g at delivery. But many barriers to access remain.<\/p>\n The need for human milk is critical because growth velocity in this population can be slow; at discharge more than half of the VLBW infants demonstrate extrauterine growth failure, with weight for gestational age less than the 10th percentile. A quarter exhibit severe growth failure.<\/p>\n Preterm birth in general affects 10.4% of US newborns; 8.6% have low birthweight and 1.4% have VLBW. The VLBW rate has fluctuated, with driving factors such as pregnancy complications and social determinants of health, according to Mandy B. Belfort, MD, MPH, a neonatologist and epidemiologist in the Department of Pediatric Newborn Medicine at Brigham & Women\u2019s Hospital and an associate professor of pediatrics at Harvard Medical School in Boston.\u00a0<\/em>Belfort did not participate in the report.<\/p>\n \u201cAddressing social inequities in provision of human milk at the local level requires access to [pasteurized human donor milk], peer lactation support, maximizing use of interpreter services as appropriate, and implementation of standardized approaches to identify and address unmet basic needs,\u201d wrote researchers led by Margaret G. Parker, MD, MPH, a professor of pediatrics and academic chief of neonatology at UMass Chan School of Medicine in Worcester, Massachusetts.<\/p>\n Part of the impetus for this report is recent lawsuits won by families whose babies developed necrotizing enterocolitis (NEC), said lead report author Parker. \u201cHuman milk is linked to reductions in NEC and late on-set sepsis and is associated with improved brain development.\u201d<\/p>\n \u201cThe risk for NEC is cut in half for babies fed human milk as their base diet as compared with those fed infant formula as their base diet\u201d added Belfort.<\/p>\n Dawnette A. Lewis, MD, MPH, director of the Center of Maternal Health at Northwell Health in New York City, noted that while the benefits of mother\u2019s milk for these babies have been established for decades, \u201cThe report serves as an updated reminder that mothers of VLBW babies need extra help. We\u2019ve found that if mothers have lactation consultation before delivery, they\u2019re more likely to breastfeed.\u201d<\/p>\n Lewis, who was not involved in the report, strongly advised that discussions about lactation be a routine part of prenatal care and preparation for childbirth. \u201cBut most patients won\u2019t have this conversation until after delivery.\u201d<\/p>\n At preterm birth, the normal transfer of nutrients from mother to baby is abruptly interrupted, Belfort explained. \u201cVLBW infants weigh 3 lb or less and need to sustain a high rate of growth and they have higher nutrient requirements than full-term infants. Milk fortification is a way to provide all the benefits of human milk while also meeting the high nutrient requirements.\u201d<\/p>\n Base milk, the combination of human milk (maternal and\/or donor) as the base boosted with an appropriate fortifier is indicated for this population. \u201cThe report affirms the importance of pasteurized donor human milk when maternal milk is not available or is in short supply,\u201d Belfort added. \u201cFurther system-level implementation is still needed to ensure that all VLBW infants have access,\u201d she said.<\/p>\n Social inequities in human milk provision persist despite advances in overall lactation support in the US. Racial\/ethnic disparities in mother\u2019s milk provision at NICU discharge result in lower rates of human milk provision among non-Hispanic Black mothers compared with non-Hispanic White mothers.<\/p>\n Although breastfeeding initiation rates are similar across sociodemographic groups, non-Hispanic Black, low-income, and publicly insured mothers are less likely to express milk throughout the NICU stay and are more likely to stop expressing milk before NICU discharge.<\/p>\n Parker noted that round-the-clock milk expression via pumping for weeks to months and being present in the NICU to directly breastfeed is particularly hard for low-income families that must shoulder financial stressors related to transportation back and forth, competing childcare priorities, and lost wages from work.<\/p>\n \u201cIn addition, low-income families also have less access to high-quality breast pumps that maximize lactation, and their work environments can be less supportive of pumping and milk storage.\u201d<\/p>\n Other report recommendations:<\/p>\n Postdischarge plans should factor in the family\u2019s goals for breastfeeding or bottle feeding with expressed milk or formula as well as the infant\u2019s growth status and anticipated need for postdischarge milk fortification, the report\u2019s authors stressed.<\/p>\n \u201cIn addition to evidence-based practices to support lactation at the local hospital level, neonatal providers can advocate for lactation more broadly,\u201d they said.<\/p>\n Also needed are more supportive policies for families, including paid family leave and other financial assistance that allow families to spend more time with their infants and invest time in providing milk. \u201cNotably, Colorado just passed a law to support a special kind of leave for mothers of hospitalized infants. It would be great to see this spread to other states,\u201d Parker said.<\/p>\n After an infant\u2019s discharge from the NICU, the input of primary care physicians is essential, said Belfort. \u201cMothers may require support in transitioning from bottle feeding to feeding at the breast and adjusting the level of fortification as the infant grows and matures,\u201d she said. \u201cThe primary care provider can provide medical input to guide that transition, for example through frequent weight checks.\u201d<\/p>\n This report received no external funding. Parker and other coauthors had no financial conflicts of interests relevant to this work. Co-author Lisa Stellwagen disclosed nonfinancial advisory and committee relationships with Medela and is the president of Human Milk Bank Association North America. Mark L. Hudak disclosed nonfinancial advisory relationships with IBP Therapeutics and Aerogen. Belfort reported receiving research funding from the National Institutes of Health and serving as a volunteer member of the advisory board for the Mother\u2019s Milk Bank Northeast. Lewis had no conflicts of interest.<\/em><\/p>\n<\/div>\n A comprehensive clinical report in Pediatrics\u00a0has issued a call to action to promote human milk for vulnerable very-low-birthweight (VLBW) newborns weighing \u2264 1500 g at delivery. But many barriers to access remain. The need for human milk is critical because growth velocity in this population can be slow; at discharge more than half of the […]<\/p>\n","protected":false},"author":1,"featured_media":2119,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_daextam_enable_autolinks":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[2],"tags":[],"class_list":["post-2118","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/diyhaven858.wasmer.app\/wp-content\/uploads\/2026\/01\/gty-251107-breast-pump-800x450.jpg","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/2118","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/comments?post=2118"}],"version-history":[{"count":0,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/posts\/2118\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media\/2119"}],"wp:attachment":[{"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/media?parent=2118"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/categories?post=2118"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/diyhaven858.wasmer.app\/index.php\/wp-json\/wp\/v2\/tags?post=2118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"photo](\"https:\/\/img.medscapestatic.com\/vim\/live\/professional_assets\/medscape\/images\/thumbnail_library\/ht-260116-meg-parker-120x156.jpg\")
![\"photo](\"https:\/\/img.medscapestatic.com\/vim\/live\/professional_assets\/medscape\/images\/thumbnail_library\/ht-260116-dawnette-lewis-120x156.jpg\")
Preterm Birth and Nutrition<\/h2>\n
![\"photo](\"https:\/\/img.medscapestatic.com\/vim\/live\/professional_assets\/medscape\/images\/thumbnail_library\/ht-260116-belfort-mandy-120x156.jpg\")
Unlevel Playing Field<\/h2>\n
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Solutions<\/h2>\n
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