Clinical Case for Donor Milk

“Substantial clinical evidence has placed HM [human milk] feeding and donor HM as a basic right for preterm infants…banked donor human milk should be promoted as a standard component of health care for premature infants.”1

Human milk is important to the health of all infants, but it affects even more profoundly morbidity and mortality among preterm infants. This nutrient-rich milk is easily digested, but nutrition is only one of its many functions. Its other functions—including improving host defense, enhancing immunomodulation, and speeding gastrointestinal and neurological development2–may be even more important to premature infants.

The anti-inflammatory and anti-infective factors in human milk have been found to protect tiny preterm infants against both NEC3-6 and sepsis.7 A dose-response relationship has been found, with a greater percentage of human milk consumption associated with lower rates of NEC and infection, including meningitis.8,9
After a thorough review of the research, the Surgeon General wrote in her 2011 Call to Action to Support Breastfeeding:

“Use of infant formula introduces multiple health risks, such as NEC, in addition to the inherent health risks of prematurity and low birth weight…Human milk is vital to the survival of vulnerable neonates and plays an important role in addressing the substantial burden imposed by NEC on affected families and in reducing health care costs associated with NEC.”10

Although about 92% of full-term babies can tolerate infant formula, the preterm gut is much more vulnerable. The Surgeon General estimates that use of exclusive formula feeding increases preterm babies’ risk of NEC by 138%.11 Premature infants who are fed formula also experience more episodes of feeding intolerance8 and attain full enteral feedings later than their human-milk-fed counterparts.12

In contrast to formula, human milk is a dynamic fluid that contains a wealth of protective factors. Antibodies, enzymes, growth factors, antioxidants, and oligosaccharides all serve important protective functions. The use of human milk has been correlated with a reduced length-of-stay in the NICU.5 Among ELBW infants, even after hospital discharge, early human milk consumption is associated with fewer hospital readmissions during the first year13 and better neurodevelopmental scores after 30 months.14

Most mothers of premature infants know how important their milk is to their baby. However, many struggle to produce the volume of milk their baby needs. Research indicates that mothers of preterm infants are about 3 times more likely to have low milk production than term mothers.15

Due to the health risks associated with the use of infant formula, in the absence of mother’s milk pasteurized donor human milk (PDHM) is needed. Even after processing, PDHM provides many of the same protections as mother’s own milk. A recent systematic review and meta-analysis concluded that feeding preterm infants formula rather than PDHM increases the risk of NEC by 2.5 times.16 Exclusive human milk feedings utilizing PDHM are an essential component of any NICU nutrition program.

References
1 Arslanoglu, S., Ziegler, E. E., Moro, G. E. (2010). Donor human milk in preterm infant feeding: Evidence and recommendations. Journal of Perinatal Medicine, 38(4), 347-351.
2 Wight, N., Morton, J.A., &Kim, J.H. (2008). Best medicine: Human milk in the NICU. Hale Publishing: Amarillo, TX, pp. 44-50.
3 Lucas, A. & Cole, T. J. (1990). Breast milk and necrotizing enterocolitis. Lancet, 336. 1519-1523.
4 Meinzen-Derr, J., Poindexter, B., Wrage, L., Morrow, A. L., Stoll, B., & Donovan, E. F. (2009). Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. Journal of Perinatology, 29, 57-62.
5 Schanler , R. J., Shulman, R. J., & Lau, C. (1999). Feeding strategies for premature infants: Beneficial outcomes
of feeding fortified human milk versus preterm formula. Pediatrics,103(6), 1150-1157.
6 Sisk, P. M., Lovelady, C. A., Dillard, R. G., Gruber, K. J., & O’Shea, T. M. (2007). Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birthweight infants. Journal of Perinatology, 27, 428-433.
7 Ronnestad, A. et al. (2005). Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feedings. Pediatrics, 115(3), e269-e276. doi:10.1542/peds.2004-1833
8 Sisk, P. M., Lovelady, C. A., Gruber, K. J., Dillard, R. G., & O’Shea, T. M. (2008). Human milk consumption and full enteral feeding among infants who weight less than or equal to 1250 grams. Pediatrics, 121(6), e1528-e1533. doi:10.1542/peds.2007-2110
9 Hylander, M.A., Strobina, D.M., & Dhanireddy, R. (2003). Human milk feedings and infection among very low birth weight infants. Pediatrics, 102(3), e38.
10 U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011, p. 27.
11 Ibid., p. 2.
12 Boyd, C. A., Quigley, M. A., & Brockelhurst, P. (2007). Donor breast milk versus infant formula for preterm infants: Systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 92, F169-F175. doi:10.1136/adc.2005.089490
13 Vohr, B.R., Poindexter, B.B., Dusick, A.M., McKinley, L.T., Wright, L.L., Langer, J.C., & Poole, W.K. (2006). Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics, 118(1), e115-e123.
14 Vohr, B.R., Poindexter, B.B., Dusick, A.M., McKinley, L.T., Higgins, R.D., Langer, J.C., & Poole, W.K. (2007). Pediatrics, 120(4), e953-e959.
15 Hill, P. D., Aldag, J. C., Chatterton, R. T., & Zinaman, M. (2005). Comparison of milk output between mothers of preterm and term infants: The first 6 weeks after birth. Journal of Human Lactation, 21(1), 22-30.
16 Quigley, M., Henderson, G., Anthony, M. Y., & McGuire, W. (2007). Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews.Issue 4, Art. No: CD002971. DOI: 10.1002/14651858.CD002971.pub2. Retrieved July 4, 2009, from John Wiley & Sons, Ltd.: