Nursing researcher examines donor human milk as clinical intervention to help infant microbiome

Babies in their first two years of life undergo so much development of their neurological, immune and endocrine systems, a healthy microbiome is key. Dr. Merilee Brockway, BN'04, PhD'19, an assistant professor with UCalgary Nursing, says that, if the infant gut microbiome is disrupted during that critical window of the first early months of life, this can set them up for diseases later on. That’s why she’s looking at ways to try and repair gut microbiomes in infants.

“I'm working on the developing infant microbiome, looking particularly at early life exposures so things like how babies are delivered, if it's vaginally or caesarean section, if they're exposed to antibiotics and how they're fed,” she says. “Those are three primary components of how their microbiome develops.”

Brockway’s research focuses on infant feeding, specifically breast milk and donor human milk’s impact on health outcomes for vulnerable infants with adverse early life exposures.

Brockway was born and raised in Canmore and did her microbiology degree at the University of Lethbridge. She did her Bachelor of Nursing at UCalgary and, for her PhD, she examined maternal breastfeeding self-efficacy and infant-feeding outcomes in moderate- and late-preterm infants. Brockway also completed a three-year postdoctoral fellowship at the University of Manitoba exploring human composition and clinical applications of donor human milk for preterm infants. This fall, she returned to her alma mater as a faculty member.

What got you into nursing to start and what inspired your research focus?

The first time I got to work in postpartum and watch and work with a breastfeeding family was just awe-inspiring for me. I was like, “This is the coolest thing ever — these babies can live on milk for six months.” So I worked to get my international board-certified lactation consultant designation and then came back to grad school wanting to do research on breastfeeding.

I was just entering practice when recommendations around exclusive breastfeeding and breastfeeding beyond infancy came out. And I had a few personal experiences with having babies myself. I had one baby where I had to have antibiotics when I was in labour. My other two, they’re all siblings in the exact same environment, same genetics, same breastfeeding and birthing experiences, and my other two have never been on antibiotics, ever. My middle one that had the exposure in labour was on several courses of antibiotics before he was five; he was always sicker than them. That just got me thinking, you know what, this is really weird, what's happening here? So I just started looking back into the microbiome.

I brought the breastfeeding aspect of my nursing in with my postdoc and microbiology — human milk is biochemically related to the microbiome — so now they're bridging together in my program of research.

Can you tell us more about your research?

Human milk feeding, we know, is really good for the microbiome, but about 60 per cent of babies will get a bottle in their first week of life just because we want them to gain weight and we want them to eat, so it's really, really common for supplementation to occur. Formula does disrupt their microbiome. We know that up to three months, even one bottle can disrupt a microbiome.

I'm looking at using donor human milk instead of formula to see if we can keep the microbiome fairly homeostatic or normal and even if we can repair it, reducing the damage on the microbiome. It's kind of short-term, and then I want to see if that, in turn, relates to different health outcomes.

Tell us more about your work with the NorthernStar Mothers Milk Bank

They are a really unique institution because they’re the only community milk bank in Canada. All the other Canadian milk banks are attached to hospitals, so they’re kind of dedicated to working with that hospital.

They give milk to 26 hospitals across Canada. They are not tied to AHS [Alberta Health Services], so there’s a lot more freedom to do research and they do a lot of community initiatives like breastfeeding classes, both postpartum and prenatally, and lots of community outreach. They're so innovative and looking for ways to do things differently, so it's been a really good partnership.

Patient-oriented research is a big part of your work. What does it mean?

[As nurses,] we do patient-centred care. It's a huge component of the care that nurses provide, so it's a really natural complement to do patient-oriented research. I think a lot of qualitative research is naturally patient-oriented. I think, if you talk to anyone on the street and say microbiome, they'll have some idea what it is. But we don't actually interact with our communities about what it is, what they think it is, what we need to research and what they think is meaningful. I’m bringing parents in early to ask them what they're interested in learning about and then integrating some of those outcomes into the trials — having parents throughout the entire clinical trial process so they can provide feedback so that when it's time to disseminate the knowledge, we make sure the right messaging is getting out. It’s really thinking about providing information so that they can be conscious consumers and targeting research to what's meaningful for them.

What do you hope to see as your research impact, and where is this research going?

Ideally, that donor human milk becomes more mainstream to people who think they have fairly normal or low-risk deliveries. Even someone who has a C-section, we don't think that's a big deal, but we do know that that will disrupt your microbiome. It also disrupts your breastfeeding, usually. It would be great if we could replace formula in hospitals with donor human milk, but we're going to have to have some pretty compelling evidence to justify the cost.

Outside of research and academia, what do you do for fun?

Hiking, for sure. When hiking isn't happening, I cross-country and downhill ski, but lots more cross-country lately. I love to read for fun, usually historical fiction. And then, of course, I have three kids, so they keep me very busy.