Are babies given expressed breast milk (mother’s own or donor human milk) less likely to develop neonatal hypoglycaemia?

Prioritise breastfeeding where possible rather than expression of breastmilk for preventing or treating neonatal hypoglycaemia in the first 48 hours after birth. [Conditional recommendation]

Very low certainty evidence from one randomised controlled trial (RCT) suggests that supplementation of breastfeeding with donor breastmilk or formula, but not mother’s own breastmilk, may increase blood glucose concentrations in hypoglycaemic babies in the first 48 hours after birth.

However, breastfeeding hypoglycaemic babies in the first 48 hours reduced the likelihood of hypoglycaemia recurring. Thus, mothers should be encouraged to breastfeed rather than to express breastmilk to feed to their baby.

Mothers should be well supported to breastfeed in preference to breastmilk expression. The increase in blood glucose concentration after breastfeeding is greater after longer feeds (>30 minutes) and after feeding from both breasts, so encouraging these practices may be helpful for babies at risk of or experiencing neonatal hypoglycaemia.

Expression of breastmilk may help support lactation if effective breastfeeding is not possible, although there is no evidence the expressed breastmilk will help prevent hypoglycaemia. If a baby is already hypoglycaemic, give oral dextrose gel and offer a feed, which could include expressed breastmilk if breastfeeding is not appropriate.
Many mothers face challenges and negative experiences when trying to express breastmilk, but some mothers of unwell or preterm babies may find it empowering to contribute to their baby's well-being through expressing milk.

Nil.

Studies are needed on:

1. The effectiveness of donor milk for preventing and treating hypoglycaemia.
2. The effectiveness of expressed breastmilk (mother’s or donor milk) for treating neonatal hypoglycaemia.

The acceptability of donor milk is individual for whānau Māori, so each whānau group should be asked what their preference is, including acceptability of donor milk before giving to pēpi. Harm occurs when health professionals do not engage with whānau about their cultural preferences.

Accessibility of donor milk is a concern, especially outside major centres where NICUs and milk banks are scarce. In Aotearoa New Zealand, systemic inequities impact access to lactation consultants and the establishment of donor milk banks.