Factors associated with infants receiving their mother's own breast milk on discharge from hospital in a unit where pasteurised donor human milk is available.

AIM: To determine the proportion of very preterm infants who were exclusively fed breast milk at the time of discharge home, before and after the availability of pasteurised donor human milk (PDHM). METHODS: This was an observational retrospective cohort study with historical comparison, comparing two cohorts (<32 weeks gestational age or very low birthweight) before and after the availability of donor human milk. The main explanatory variable was the PDHM cohort: pre-PDHM or post-PDHM. The primary dichotomous outcome variable was defined as whether the baby was being fed with breast milk only at the time of discharge home, compared with those fed with artificial formula alone or mixed feeding (artificial formula and breast milk). RESULTS: There were 1088 babies in the pre-PDHM cohort and 330 in the post-PDHM cohort (total n = 1418). Following the introduction of PDHM, 56% (185/330) were exclusively fed breast milk at the time of hospital discharge and 57% (620/1088) in the pre-PDHM cohort. The availability of PDHM is not a significant predictor of feeding outcome upon discharge (P = 0.45) when adjusted for maternal age, log-transformed post-natal age at discharge home and any congenital abnormality. CONCLUSIONS: The availability of donor human milk in our unit is not associated with a decrease in the number of very preterm infants receiving mother's own breast milk at time of discharge home. Other factors that positively impact the successful establishment of breastfeeding in preterm babies were older maternal age, the absence of any congenital abnormality and a shorter duration of hospital stay.

Study of movement of umbilical venous catheters over time.

AIM: To quantify, in well-positioned umbilical venous catheters (UVC), the direction and magnitude of catheter tip migration. METHODS: In this prospective, single-centre, observational, cohort study, infants with a UVC inserted that reached the target zone - inferior vena cava, from ductus venosus to cavoatrial junction (CAJ) - were included. Ultrasound was used to position the catheter tip as near to the CAJ as possible at insertion and to guide any subsequent withdrawals of the catheter. Radiographs and ultrasound were repeated the day following the insertion of the UVC and on any day following adjustment. A final scan was performed on the day of catheter removal. The anatomical position of the catheter and its distance from the CAJ was recorded with each scan. RESULTS: The study ran from May 2015 to August 2016 in the neonatal unit at the Royal Brisbane and Women's Hospital. Thirty-eight patients were recruited, but 18 failed to negotiate the ductus venosus. For the remaining 20, the initial UVC position was within 3 mm of the CAJ on ultrasound. Subsequently, on day 2, 25% of catheters were well positioned, 65% were high and 10% were below the target zone. On the late scan prior to UVC removal, 90% of catheters had migrated from their position on the preceding scan: outward migration in 80% of cases ranging from 2 to 23 mm (median 8.5 mm). Only 35% of catheters remained well positioned. CONCLUSION: The majority of UVCs migrate over time, usually inwards initially and then outwards to a low position.