The Risks and Benefits of Human Donor Breast Milk

Abstract

CME EDUCATIONAL OBJECTIVES: 1.Review the advantages and disadvantages of donor-banked milk over informal milk sharing.2.List disadvantages of proprietary infant formula for use as supplementation.3.Determine the primary ethical concerns when electing to use donor human milk versus propriety infant formula for supplementation. The benefits of breast-feeding, as well as the risks of some artificial formula, are well known. This growing recognition of the advantages of breast-feeding is reflected in the increased incidence of breast-feeding in recent years. However, one of the most common reasons for premature weaning is low milk supply, perceived or real, followed by nipple or breast pain. Given the increased awareness of the superiority of breast milk, however, more parents are turning to human donor milk to supplement their babies after they have been weaned.

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

“…When mother’s milk is not available, PDM is a reasonable alternative for the preterm infant; however, PDM does not meet the nutritional needs of infants that are preterm or ingesting low volumes of milk if fed as the sole source of nutrition, and thus requires supplementation [9,10,11,39]. While women donating to human milk banks undergo extensive medical screening, there are many variables that are not controlled.…”

“…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].…”

Human milk sharing practices in the U.S.

“…Controversies surrounding milk sharing emanate from concerns about the potential risks involved in feeding an infant with human milk donated by individuals who are not systematically screened by a trained health professional (Geraghty et al 2011;Gribble & Hausman 2012;Nelson 2012;Brent 2013;Jones 2013;Landers & Hartmann 2013;Keim et al 2014a,b). These risks include transmission of disease, exposure to medications and substances, and microbial contamination associated with storage and handling practices (Golding 1997;U.S.…”

“…These risks include transmission of disease, exposure to medications and substances, and microbial contamination associated with storage and handling practices (Golding 1997;U.S. Food and Drug Administration, 2010;Walker & Armstrong 2012;Brent 2013;Landers & Hartmann 2013;Martino & Spatz 2014). Other tensions have arisen around the potential negative impact of milk sharing on the supply of donor milk to nonprofit human milk banks (Jones 2003;Updegrove 2013a,b).…”

“…;Cohen et al 2010;Landers & Updegrove 2010;Akre et al 2011;Geraghty et al 2011;Gribble & Hausman 2012;Nelson 2012;Brent 2013;Geraghty et al 2013;Keim et al 2013Keim et al , 2015Landers & Hartmann 2013; Updegrove 2013a,b;Gribble 2014c; Keim et al 2014a, b;Martino & Spatz 2014;Carter et al 2015)…”