The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit

FROM THE NATIONAL ASSOCIATION OF NEONATAL NURSES This revised position statement from the National Association of Neonatal Nurses (NANN) affirms that human milk and breastfeeding are essential, evidence-based components of care for infants hospitalized in the neonatal intensive care unit (NICU). The statement emphasizes the critical role of neonatal nurses in ensuring equitable access to human milk and lactation support to improve survival, reduce morbidity, and optimize neurodevelopmental and health outcomes for vulnerable infants.1 BACKGROUND AND SIGNIFICANCE Human milk is a lifesaving medical intervention for preterm infants, infants requiring surgery after birth, infants with congenital anomalies, and other vulnerable infants. Although national and international organizations recommend exclusive human milk feeding for the first six months of life, breastfeeding exclusivity and duration in the United States remain suboptimal, especially among families with infants requiring intensive care.1,2 These gaps contribute to preventable morbidity, mortality, and persistent health disparities.3 Robust evidence demonstrates that human milk reduces the incidence and severity of necrotizing enterocolitis, sepsis, respiratory and gastrointestinal infections, and hospital-acquired infections, while supporting immune maturation, intestinal integrity, and brain development.1,3-5 For infants at high risk for inflammatory injury or neurodevelopmental impairment, human milk functions as a lifesaving and neuroprotective intervention.4,5 Population-level analyses suggest that widespread exclusive human milk feeding could reduce infant mortality by up to 20%–22%, underscoring its public health importance.3 Neonatal nurses are uniquely positioned to influence human milk outcomes through direct care, education, advocacy, and systems-level practice change, making an updated and evidence-based position statement essential to guide NICU practice. NEW CHANGES This revision incorporates significant advancements in science, clinical practice, and policy. Key updates include: Alignment with current national and international guidance, including updated recommendations from the American Academy of Pediatrics, Centers for Disease Control and Prevention, World Health Organization, and Healthy People 2030.1,2 Expanded focus on health equity, addressing persistent racial disparities in breastfeeding initiation, duration, and infant outcomes, and reinforcing the responsibility of neonatal nurses to promote equitable access to human milk.3 Updated evidence on neurodevelopmental and immunologic benefits, including emerging research on the human milk microbiome, metabolome, and dose-response relationships between human milk exposure and infant outcomes.4,5 Contemporary clinical guidance addressing substance use, cannabis exposure, and HIV, emphasizing individualized, shared decision-making approaches that balance risk reduction with the substantial benefits of human milk.1,2 Continued application of the Spatz 10-Step Model, providing a standardized, evidence-based framework for prenatal lactation intervention, establishment and maintenance of milk supply, oral care with human milk, milk management and prioritization, fortification considerations, and transition to direct breastfeeding.1 Strengthened emphasis on the role of the bedside neonatal nurse, highlighting nursing responsibilities in lactation assessment, education, documentation, milk volume monitoring, and interdisciplinary coordination.1 Updated evidence related to milk handling, storage, and fortification, supporting practices that preserve bioactive components of human milk while optimizing growth and clinical outcomes.1,4 These revisions ensure that the position statement reflects current evidence, evolving clinical practice, and the complex needs of NICU families. CONCLUSION As the professional voice of neonatal nurses, the National Association of Neonatal Nurses recommends that neonatal nurses promote, protect, and support the provision of human milk and breastfeeding for all infants in the neonatal intensive care unit through evidence-based practice, family-centered care, and advocacy that addresses health disparities.1,3 The full NANN position statement can be accessed at https://nann.org/about/position-statements. —Diane L. Spatz, PhD, RN-BC, FAWHONN,FAANUniversity of Pennsylvania School of Nursingand the Children’s Hospital of Philadelphia,Philadelphia, PA —Taryn M. Edwards, MSN, APRN, NNP-BCNemours Children’s Health Delaware,Wilmington, DE, and the Children’s Hospital ofPhiladelphia, Philadelphia, PA