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Donor Human Milk May Decrease Severe Gastrointestinal Distress in Infants with Neonatal Abstinence Syndrome

Catherine Alexander, Paula Radmacher, Lori Devlin

Introduction: Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome that occurs after antenatal exposure to opiates. Symptoms generally peak at 48-72 after delivery. One of the postnatal challenges for infants with NAS is feeding intolerance. The use of mother’s own milk has been reported to improve NAS symptoms when compared to formula. However, the American Academy of Pediatrics (AAP) considers the unsupervised use of opiates and other street drugs to be a contraindication to breastfeeding. We wanted to test the efficacy of donor human milk to ease gastrointestinal symptoms in infants with NAS who cannot receive their mother’s milk. Methods: Infants whose initial withdrawal symptoms had been stabilized on morphine and whose mothers were not providing their milk were eligible to be enrolled. Infants were fed only donor human milk (DHM) for a period of up to 2 weeks. Finnegan scores, oral morphine dosing, and adjuvant therapy were prescribed according to a standardized protocol. Twelve infants were enrolled in the study and 9 infants completed at least 7 days of exclusive DHM feedings. Infants were matched 1:1 to historic controls with similar perinatal exposure who were formula-fed. Results: Median Finnegan scores were not statistically different between the study and control groups. However, the proportion of infants with GI sub-scores greater than 2 was significantly higher in the control group when compared to infants who received DHM (p=0.001). Conclusions: The present pilot study suggests that feeding with DHM may decrease severe GI distress