The Impact of Opt-In versus Opt-Out Consent Process for the Use of Donor Human Milk on Feeding Practice and Growth Pattern in Preterm Neonates

This study aimed to assess the impact of an opt-out consent process compared with the opt-in consent process for using pasteurized donor human milk (PDHM) on feeding practices and growth in preterm neonates.A retrospective study of 200 neonates ≤28 weeks' gestation compared the effects of opt-in versus opt-out consent processes on time to first enteral feed, feeding types, growth trajectories, and prematurity-related morbidities. Descriptive statistics were used to compare the two groups.The opt-out process did not significantly alter the time to the first enteral feed (range opt-in: 0-12 days vs. opt-out 0-5 days, Mann-Whitney U; <i>p</i> = 0.295). Compared with the opt-in process, the opt-out process was associated with less formula use, less mother's milk use, and more PDHM/mixed mom's milk-PDHM use in the first 4 weeks of life (<i>p</i> < 0.01). Unadjusted analyses showed a greater weight gain in the opt-out group on days of life/DOLs 14 and 28 (2.49 [0.20, 4.78] and 3.94 [0.07, 7.80]%, <i>p</i> < 0.05), and following adjustment, it remained significant for DOL 14 (1.87 [0.02, 3.71]). Prematurity-related morbidities were similar between the two groups.The opt-out consent process may impart short-term growth benefits in preterm infants. However, long-term outcomes require further study. · Opt-out is an alternative to the traditional opt-in consent for donor milk use in preterm infants.. · It is associated with better growth by day 14.. · Less formula use, and more donor/mixed milk use by day 28.. · Mother's milk use at discharge and short-term outcomes are similar for both consent types.. · Future studies will focus on the long-term effects and benefits of the opt-out consent process..