Abstract
BACKGROUND: When mother's own milk (MOM) is insufficient, feeding very preterm infants with donor human milk (DHM) reduces the incidence of multiple severe complications and provides greater benefits than infant formula. Donor human milk (DHM) is obtained from breast milk banks, but establishing a human milk bank is very expensive. We propose a same-city delivery model for donor human milk (SCDM-DHM), where DHM is delivered via a cold chain from milk banks to NICUs without milk bank facilities, providing DHM to very preterm infants (VPIs). METHODS: We retrospectively analyzed the medical records of VPIs who were admitted to Shenzhen People's Hospital between June 2023 and May 2025. We initiated the same-city delivery model for donor human milk (SCDM-DHM) in July 2024, providing DHM to VPIs born from June 2024 onward. We designated VPIs admitted from June 2023-June 2024 as the control group and those admitted from June 2024-May 2025 as the SCDM-DHM group. The economic benefits for both the human milk bank and recipient hospitals within the SCDM-DHM were evaluated, and clinical outcomes were assessed in VPIs receiving DHM in recipient hospital NICU. RESULTS: Our cost analysis revealed that the cost of the human milk bank is much greater than the cost of the recipient hospital ($526,576.40 vs. $279.58). The recipient hospital's cost per liter DHM ($25.34) is much lower than that of the human milk bank ($44.94). Our data revealed that after DHM was introduced, the breastfeeding rate of VPIs in recipient hospital NICU was higher (50.8% vs. 92.9%, p < 0.001, SMD=-1.09). The incidence of NEC (≥ Stage II) (6.7% vs. 3.5%) was not significantly different (p = 0.679, SMD = 0.14) from that in the control group, with a complete absence of adverse events. CONCLUSIONS: The SCDM-DHM is an adaptation of existing international approaches to the unique infrastructure and policy environment in China. The SCDM-DHM improved breastfeeding rate in the NICU without a human milk bank and remained cost-efficient, demonstrating both feasibility and clinical effectiveness. However, more research is needed to confirm whether the SCDM-DHM can be promoted among NICUs in Shenzhen and other regions as well.