In-hospital peer-supported human milk bank management model and its association with human milk feeding proportions and clinical outcomes in extremely preterm infants: a recipient-to-voluntary-donor approach

Human milk feeding proportions among preterm infants remain unsatisfactory, and donor human milk is recommended as the best alternative when mother’s own milk is insufficient. Although established human milk banks provide essential donor human milk services, some settings may face challenges related to donor continuity and the timely alignment of donor milk supply with recipient demand. We therefore developed an in-hospital peer-supported human milk bank management model featuring a structured recipient-to-voluntary-donor pathway within the same neonatal unit. This peer-supported model was implemented at Shenzhen Maternity and Child Healthcare Hospital in January 2024. In this retrospective analysis, extremely preterm infants admitted from January to December 2023 served as the control group and received the usual feeding practice, with mother’s own milk supplemented by preterm formula when insufficient. Infants admitted from January to December 2024 comprised the human milk bank group and received donor human milk from the in-hospital peer-supported bank when maternal milk was insufficient. Clinical outcomes including human milk feeding proportions, necrotizing enterocolitis, and bronchopulmonary dysplasia were compared between the two groups to examine the associations between implementation of the model and human milk feeding proportions and clinical outcomes. Human milk feeding proportions were significantly higher in the human milk bank group than in the control group during the first 7 days of life (100% vs. 49%, P < 0.001) and during the first 28 days of life (100% vs. 98%, P < 0.001). Total enteral intake volume was significantly higher in the human milk bank group than in the control group during the first 7 days of life (44.5 mL vs. 38.5 mL, P = 0.002), and during the first 28 days of life (1377.8 mL vs. 1079.0 mL, P < 0.001). The incidence of moderate to severe bronchopulmonary dysplasia was significantly lower in the human milk bank group (OR = 0.533, 95% CI 0.291–0.978, P = 0.042), whereas the adjusted association with stage II or above necrotizing enterocolitis was not statistically significant (OR = 0.226, 95% CI 0.042–1.224, P = 0.084). The in-hospital peer-supported human milk bank model was significantly associated with higher human milk feeding proportions during the first 7 days of life and during the first 28 days of life, as well as lower odds of moderate-to-severe bronchopulmonary dysplasia in extremely preterm infants. This model may represent a simple, peer-supported, and potentially scalable strategy for optimizing human milk feeding support in neonatal intensive care units.