Human Milk, Nutrition, Growth, and Breastfeeding (Hummingbird)
Research type
Research Study
Full title
Human Milk, Nutrition, Growth, and Breastfeeding Rates at Discharge: The Hummingbird Study
IRAS ID
281071
Contact name
Nicholas D Embleton
Contact email
Sponsor organisation
Newcastle Hospitals NHS Trust
ISRCTN Number
ISRCTN57339063
Duration of Study in the UK
1 years, 8 months, 1 days
Research summary
This is a non-blinded, randomised trial exploring two currently used diets in preterm infants which both involve fully supporting mothers to provide their own breast milk and standard use of donor human milk to make up any shortfall in mothers' breast milk supply. The primary outcome is breastfeeding at discharge. Mothers will be approached by the clinical team and infants enrolled after signed informed consent. Infants do not undergo any additional interventions or tests, and all data used are routinely collected. Mothers will complete short questionnaires and a subset invited to take part in qualitative interviews. The intervention finishes at hospital discharge, but up to two telephone calls post-discharge will be made to ascertain duration of prolonged breastfeeding.
The study compare diets routinely used in neonatal units in UK by comparing the use of DHM to make up any shortfall until full feeds (control) to that of using DHM for a longer duration up to the pre-discharge period (intervention).
There are no changes to the patient journey except for the duration of donor milk use. Most babies get good amounts of their own mother's milk over first few weeks but the amount typically decreases over time. Almost all babies will likely receive at least small amounts of donor milk until around day 10. After that, half the babies will continue to receive some donor milk if they are in the intervention arm for another 1-4 weeks on average; whereas in the control arm they receive standard care which is to use a preterm formula milk. There are no obvious risks or ethical issues.
Summary of results
Mother’s own breastmilk is best for preterm babies, but many mothers cannot produce enough milk to meet their baby’s needs. Clinicians use either donor human milk or specialised preterm formula to supplement the shortfall. Hospitals vary widely in how long they use donor milk and there is little evidence on whether longer use improves babies’ growth and feeding outcomes. This study compared using donor human milk for short period (until babies tolerated full milk feeds) versus long-term (until 36 weeks of gestation or discharge, if earlier), when mother’s own breastmilk supply was limited.
The main aim was to see if it was possible to run a randomised study comparing different ways of using donor milk, and whether babies were still being fed mother’s own breastmilk at 36 weeks of gestation or at discharge (if they went home earlier). We also collected information on babies’ growth and health. This study helps to fill a gap, as no previous studies have tested different donor milk approaches while looking at breastfeeding outcomes.
Between June 2021 and March 2023, 135 babies from two neonatal units in the North East of England took part in HUMMINGBIRD trial. Of these, 69 babies received donor human milk up to 36 weeks of gestation when there was not enough mother’s own milk; while 66 babies received donor milk until they tolerated full feeds and then received preterm formula if needed.
The findings show that although the proportion of babies receiving mother’s own breastmilk at 36 weeks of gestation or discharge (if earlier) was similar in both groups, it was a lot higher compared to previous years. There were no differences in growth and health outcomes between the groups. Interviews with mothers showed that they found expressing of breast milk often hard. Donor milk either helped mothers feel reassured or, for some, created discomfort that encouraged them to express more. Supporting the use of donor milk may also reinforce message about the importance of breast milk over formula. Our study showed that running this type of randomised trial is feasible and that donor milk was generally well accepted. The length of time donor milk is used use may not by itself affect how much mother’s own milk babies get, but it can influence families and staff in many ways and the effect will depend on care setting.REC name
East Midlands - Nottingham 2 Research Ethics Committee
REC reference
21/EM/0041
Date of REC Opinion
25 Feb 2021
REC opinion
Favourable Opinion