The evidence appraisal in this revised American Academy of Pediatrics policy statement endorses the practice of supporting mothers to express breast milk for their preterm infants using evidence-based interventions. The challenge is to ensure that these are implemented consistently and broadly, and especially to vulnerable and socially disadvantaged women who are less likely to provide expressed breast milk. However, the statement recommending that preterm infants should receive “Pasteurized donor human milk, appropriately fortified” if the mother’s own expressed breast milk is unavailable is not supported fully by the current evidence.1 Whether donor human milk is the optimal alternative when maternal milk is not available requires consideration of feasibility, costs, acceptability, and the effect on other important clinical outcomes, principally growth and development.1 Although good-quality evidence applicable to the modern context of neonatal nutritional care is emerging,2 additional large, pragmatic randomized controlled trials are needed to provide more reliable and precise estimates of effect size and to explore cost-effectiveness. I am concerned that, without qualification, the advice in this American Academy of Pediatrics Policy Statement may have the unintended consequence of discouraging clinicians and service users from developing and participating in randomized controlled trials to address the remaining uncertainties.
- Copyright © 2012 by the American Academy of Pediatrics