Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States

Breastfeeding, Section On; Newborn,

doi:10.1542/peds.2016-3440

Cited by 242 publications

(113 citation statements)

References 30 publications

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“…Epidemiological investigations have determined that feeding mother’s own milk decreases the likelihood of necrotizing enterocolitis and late-onset sepsis in preterm infants [4,5,6], resulting in shorter hospital stays and decreased cost of care [7,8]. When mother’s own milk is not available, pasteurized donor milk (PDM) is used as a reasonable alternative for the preterm infant [9,10,11,12,13]. To achieve this practice, mother’s own milk is often augmented with pasteurized donor milk [14].…”

Section: Introductionmentioning

confidence: 99%

Lactational Stage of Pasteurized Human Donor Milk Contributes to Nutrient Limitations for Infants

et al. 2017

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Background. Mother’s own milk is the first choice for feeding preterm infants, but when not available, pasteurized human donor milk (PDM) is often used. Infants fed PDM have difficulties maintaining appropriate growth velocities. To assess the most basic elements of nutrition, we tested the hypotheses that fatty acid and amino acid composition of PDM is highly variable and standard pooling practices attenuate variability; however, total nutrients may be limiting without supplementation due to late lactational stage of the milk. Methods. A prospective cross-sectional sampling of milk was obtained from five donor milk banks located in Ohio, Michigan, Colorado, Texas-Ft Worth, and California. Milk samples were collected after Institutional Review Board (#07-0035) approval and informed consent. Fatty acid and amino acid contents were measured in milk from individual donors and donor pools (pooled per Human Milk Banking Association of North America guidelines). Statistical comparisons were performed using Kruskal–Wallis, Spearman’s, or Multivariate Regression analyses with center as the fixed factor and lactational stage as co-variate. Results. Ten of the fourteen fatty acids and seventeen of the nineteen amino acids analyzed differed across Banks in the individual milk samples. Pooling minimized these differences in amino acid and fatty acid contents. Concentrations of lysine and docosahexaenoic acid (DHA) were not different across Banks, but concentrations were low compared to recommended levels. Conclusions. Individual donor milk fatty acid and amino acid contents are highly variable. Standardized pooling practice reduces this variability. Lysine and DHA concentrations were consistently low across geographic regions in North America due to lactational stage of the milk, and thus not adequately addressed by pooling. Targeted supplementation is needed to optimize PDM, especially for the preterm or volume restricted infant.

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Section: Introductionmentioning

confidence: 99%

Lactational Stage of Pasteurized Human Donor Milk Contributes to Nutrient Limitations for Infants

et al. 2017

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“…Human donor milk has been advocated as the first alternative in preterm infants when own mother's milk is not available. Even though it has been criticized for potentially being not cost effective, human donor milk should be considered and implemented as a "bridge" to own mothers' milk, in consideration of the individual-specificity of human milk and of the importance of breastfeeding for the mother's health [9].…”

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confidence: 99%

Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done

2019

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Keywords: breastfeeding; human milk; human donor milk; promotion of breastfeeding; preterm infant; VLBW Human milk is recommended as the natural feeding for both term and preterm infants for the several health benefits associated with its consumption. The importance of human milk is not only limited to its nutritional value but it also includes the provision of bioactive factors involved in the optimization of infants' growth and neurodevelopment. A huge amount of researches indicates that the biological effects of human milk are dose dependent. Moreover, an increasing number of studies are showing that breast milk contains stem cells whose implications in infant neurodevelopment are under study. Hence, it is mandatory to promote initiation of breastfeeding as well as to support its duration [1][2][3][4].When taking into consideration feeding options for preterm infants, it should be highlighted that there is a biological hierarchy with milk of own mothers' being the first choice. When own mothers' milk is not available, donor human milk is recommended, whereas formula feeding should be the last choice [2].Human milk feeding represents a cost-effective strategy to reduce disease impact and associated costs in preterm infants, during the neonatal intensive care unit hospitalization [5]. Colaizy estimated that suboptimal feeding of extremely low birth weight infants would cost $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563,655 (CI $476,191, $599,069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death [6].The systematic review and meta-analysis published by Miller [7] summarized the available evidence in relation to the dose-dependent effect of human milk feeding on decreasing morbidity in infant born <28 weeks' gestation and/or birth weight <1500 g. Recent studies have assessed the different impact of human milk and preterm infant formula (PTF) feeding on one single outcome, thus limiting the in-depth analysis of the synergic protective co-effects led by the different nutritional and non-nutritional components of human milk against the most frequent comorbidities that affect premature infants. Remarkably, Miller considered the combination of five major morbidities (necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity and neurodevelopment), pointing out the clear protective effect of human milk against necrotizing enterocolitis and possible reduction in late onset sepsis, severe retinopathy of prematurity and severe necrotizing enterocolitis. The comparison between various combinations of mixed feeding, human milk and preterm infant formula allowed for a specific investigation on the dose effect associated with human milk feeding.However, no conclusive evidence has been drawn on the incidence of bronchopulmonary dysplasia and on neurodevelopment, thus underlining the need for implementing research towards this direction.This systematic review allows for gaining further ins...

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“…2 The utilization of donor human milk (HM) is expanding for high-risk babies, principally for newborn children conceived measuring <1500 g or those who have serious intestinal issues. 3 In preterm newborn children, there are particular benefits identified with HM that diminishes fundamentally the danger of stomach related intolerance, necrotizing enterocolitis, late-onset sepsis, bronchopulmonary dysplasia, and retinopathy of prematurity. It has likewise a long-haul positive effect on cognitive development and metabolism and cardiovascular wellbeing at grown-up age.…”

Section: Background Stating the Problemmentioning

confidence: 99%

Human milk banking can be an innovative approach for developing countries

Jahan¹,

Rahman²

2018

Health Promot Perspect

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Donor Human Milk for the High-Risk Infant: Preparation, Safety, and Usage Options in the United States

Cited by 242 publications

References 30 publications

Lactational Stage of Pasteurized Human Donor Milk Contributes to Nutrient Limitations for Infants

Lactational Stage of Pasteurized Human Donor Milk Contributes to Nutrient Limitations for Infants

Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done

Human milk banking can be an innovative approach for developing countries

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