An investigation into the status of human milk feeding in very low birth weight infants: a multicenter study

Human milk provides essential health benefits for very low birth weight infants (VLBWIs). Nevertheless, the utilization patterns of human milk in Chinese neonatal intensive care units (NICUs) remain inadequately characterized. The objective of this multicenter study was to evaluate the current status and variations in human milk feeding practices among diverse types of medical institutions, providing baseline data to support the implementation of full - process human milk feeding in NICUs. A prospective observational study was conducted from July 2021 to July 2022, involving 725 VLBWIs admitted to the NICUs of 16 hospitals in China. Data on infant demographics, clinical outcomes, and detailed feeding records were systematically collected using a standardized questionnaire. A customized human milk feeding module was developed within a multicenter database platform to ensure consistent data capture. All data were entered locally by trained research staff, with subsequent centralized auditing and validation by the research team. Statistical analyses included descriptive statistics and chi-square tests to evaluate differences in feeding practices across hospital categories. The cohort consisted of 362 males (49.9%) and 363 females (50.1%), with mean gestational age 29.08 ± 1.65 weeks and birth weight 1154.50 ± 208.27 g. The overall human milk feeding rate was 52.3%, with significant disparities among hospital types: general hospitals (4.1%), children’s hospitals (74.5%), and maternal and child health hospitals (89.7%) (χ²=362.141, P < 0.001). Donor human milk was available in 7 hospitals (43.8%), with 31.9% of infants receiving it during hospitalization. Initial feeding was predominantly formula-based (64.4%), while mother’s own milk as initial feeding was uncommon (6.5%). Exclusive human milk feeding duration averaged 53.0 days (IQR 23.0-103.0), significantly longer than exclusive formula feeding (34.0 days, IQR 13.8–46.0). Substantial variations exist in human milk feeding practices for VLBWIs across Chinese NICUs, with overall utilization rates lower than international benchmarks. These findings highlight the need for standardized protocols and enhanced support systems to promote human milk feeding in this vulnerable population.