Like most mothers, Julie Krashin was preparing for her twin babies to be delivered on their due date. But the twins came eight-and-a-half weeks early and had to be rushed to the neonatal intensive care unit (NICU) at Saint Luke’s Hospital in Kansas City.
Three days into their stay, Julie and her husband Jeremy lost their daughter Ilana.
“Having a baby in the NICU leaves you feeling a little bit helpless. You’re watching the nurses and doctors run around trying to keep your baby to stay alive, and that’s supposed to be your job,” Krashin said, echoing what she believes most parents think in the NICU.
While losing Ilana was devastating, and her family felt unlucky, she said she also felt blessed to be producing enough milk to share with other moms who weren’t making as much milk as she was, or any at all.
Krashin and her husband began donating breast milk to the Saint Luke’s Heart of America Mother’s Milk Bank, a nonprofit milk storage bank with screening and pasteurization processes in line with Human Milk Banking Association of North America (HMBANA) https://www.hmbana.org guidelines.
Kansas lawmakers are looking to increase access to the state’s milk bank stores through House Bill 2149, which would allow Medicaid to reimburse hospitals for prescribing human donor breast milk to critically ill infants, under the age of three, in the NICU.
Rep. Barbara Bollier, a Republican from Mission Hills, introduced the bill to the House Health and Human Services Committee. It passed the House 123-0 and had a hearing Monday in the Senate Public Health and Welfare Committee. That committee combined it with other health related measures.
The breast milk provision is a win-win, and allows premature babies to get what they need, instead of formula at the NICU, Bollier said.
The state budget office says the cost of the bill “would be negligible.”
Research points to many benefits
A study from the Journal of the American Academy of Pediatrics in 2012 discovered that for premature babies, human breast milk causes lower rates of sepsis and Necrotizing Enterocolitis (a serious intestinal disease), lower mortality rates, lower long-term growth problems and fewer neurodevelopmental disabilities.
Higher IQ, white matter and total brain volumes were also seen in those who received human milk as infants in the NICU, according to the study.
“Very low birth-weight babies, they don’t have that time in the womb with the mom growing the brain,” said Gwen Whittit, past chairperson of the KS breastfeeding coalition, and current program coordinator for High 5 for Mom and Baby. “Human milk really does help their function later in life.”
Barbara Carr, a neonatologist with Pediatrix Medical Group at Saint Luke’s Hospital testified Monday in support of the breast milk bill, and said human donor milk is best when a mother can’t produce milk, can’t produce enough milk, or her milk isn’t safe for the baby due to medications she’s taking.
“The biggest benefit is going to be shortened hospital stays and improved outcomes,” Carr said. “Babies that have fewer infections, they get to full feedings faster, they get rid of the intravenous medications and therapies faster and generally tolerate everything — everything is better on donor milk.”
Kansas Medicaid currently does not cover human donor breast milk because it’s seen as a nutritional supplement, so many patients have to pay for it out of pocket — which isn’t financially possible for everyone, Carr said.
Whittit said attitudes about how breast milk should be classified are changing as evidence for its medical benefits grows.
“I’ve heard some of the physicians at the lactation conference I go to yearly describe breast milk not as a supplement, but as a medication, and we cannot deny babies this medication,” Whittit said.
Hospitals picking up the tab
It’s up to hospitals to use donor breast milk as a therapy for their babies, and if they don’t use it, then babies are getting formula, which Carr said is a concern.
Despite donor breast milk not being covered by Medicaid, Wesley Medical Center in Wichita still gives it to the 175 premature babies within their care. Wesley delivers approximately 1,000 babies per year, said Paula Delmore, manager of Wesley Medical Center’s NICU.
About one-third of the premature babies are on Medicaid and because Medicaid does not cover donor breast milk, Wesley Medical Center officials estimates they will spend $400,000 covering the uncompensated costs.
“If we can prevent long-term additional costs to those babies post-discharge, that investment is well worth it.” Delmore said.
Babies suffer the consequences if breast milk isn’t given to them, she said —especially if they are less than 1500 grams — and those consequences add up in future health care costs.
"While I couldn’t save my own, I like to remember that I’ve hopefully helped to save other babies. ...We like to say Ilana gets all of our kisses, but lots of babies get her milk."- Julie Krashin, milk donor
Delmore said Wesley Medical Center wants the bill passed to improve the future health outcomes of Kansas-born babies.
“We want to be able to provide the best medical nutrition possible, and we don’t think of this as a formula. We consider it a medical intervention — we are using it in a very targeted way to prevent a devastating outcome of NEC (Necrotizing Enterocolitis),” Delmore said.
Wesley Medical Center has a milk donor program through a company called Prolacta. The company provides an online questionnaire, a lab technician comes to the donor’s home for a blood screening process and FedEx ships the donation boxes.
Prolacta tests the donor’s DNA to make sure all the milk is from the same woman. During the pasteurization process, Prolacta also creates donor milk that has four extra calories per ounce than regular breast milk, which is necessary for premature babies.
Because donor breast milk is a hot commodity, Delmore said they have a purchase agreement that for every ounce Wesley donates, they are guaranteed to purchase that many ounces.
Supplying to several states
Saint Luke’s Heart of America Mothers’ Milk Bank supplies donor milk to The University of Kansas Hospital, Overland Park Regional Medical Center, and a NICU in Topeka, among other facilities. It also provides milk to Missouri, Arkansas, Alaska, New Jersey, and many other locations across the country, according to Christine Pai, a neonatal nurse with Pediatrix Medical Group at Saint Luke’s Hospital.
Krashin said she’s happy to be part of that effort, though she does not know what families receive her donated milk.
At the end of December, Krashin donated 3,116 ounces. She said she will continue to donate to other babies as long as she’s breastfeeding her daughter, Goldie, who was released from the NICU after 90 days.
“While I couldn’t save my own, I like to remember that I’ve hopefully helped to save other babies,” Krashin said. “We like to say Ilana gets all of our kisses, but lots of babies get her milk.”