LAUSR

Background Survival outcomes remain dismal in infants undergoing HSCT. Regimen related toxicity, organ dysfunction and infections remain the major causes of TRM in infants undergoing HSCT. Better strategies for preventing infections and organ toxicity are needed to improve survival. Feeding human milk (maternal or third party) may be an important strategy in infants to prevent infections and reduce toxicity due to its beneficial effect on pro-inflammatory cytokines, local immunity and gut microbiome. There is no data in pediatric HSCT practice regarding effect of breast feeding/human milk on survival outcomes. We conducted a survey study to assess current practices among the pediatric transplant centers regarding use of human milk during HSCT and the reasons, if any for restricting it. Methods We conducted a survey of PBMTC transplant centers in US and Canada regarding the utilization of human milk. The study was IRB approved at Stanford University and only information regarding institutional practices was collected. One response from each institution was included in the analysis and descriptive statistics was used to analyze the data. Results Twenty seven centers answered the survey questions. Only three institutions allowed unrestricted breast feeding, while two did not allow any form of human milk during HSCT. Majority (81%) of the centers allowed human milk during HSCT with some restrictions. The most common restriction was the diagnosis of immune-deficiency (SCID) due to the fear of CMV transmission; but only 11 (50%) of these centers tested mothers for their CMV status. Two centers irradiated breast milk prior to feeding. Only 2 centers had a program for providing pre-tested, pasteurized human milk from third party donors to infants undergoing HSCT. Only one center had an active research program looking at use of human milk in the HSCT setting. Conclusions Though there are established immunological and microbiological benefits of human milk, its utilization is variable among pediatric HSCT centers. Majority of the institutions restrict breast feeding in infants with the diagnosis of SCID, but only half of these centers test mothers for their CMV status. Use of pre-tested, third party human milk during HSCT is very limited. More research regarding the benefits and use of human milk in infants undergoing HSCT is needed to establish standardized guidelines.