Donor Human Milk Update: Evidence, Mechanisms, and Priorities for Research and Practice.

In the last decade, the use of pasteurized donor human milk (DHM) has become the standard of care for very low birthweight (VLBW; <1500 g) infants throughout the world when mothers’ own milk (MOM) is not available. DHM banks have been established even in countries that use limited MOM feedings in the neonatal intensive care unit (NICU). Little research informs this rapid practice change. Multiple studies report that high-dose feedings of MOM during critical exposure periods in the NICU hospitalization reduce the incidence, severity, and risk of potentially preventable morbidities, including necrotizing enterocolitis (NEC); late onset sepsis; chronic lung disease; retinopathy of prematurity; rehospitalization after NICU discharge; and neurodevelopmental problems in infancy and childhood. However, this same constellation of outcomes has not been attributed to DHM feedings. Furthermore, when compared with MOM and formula-fed infants, primarily DHM-fed infants have demonstrated either slow weight gain or the need to “superfortify” DHM with exogenous bovine-based protein and other macronutrients. Separately, research and quality improvement projects have begun to merge MOM and DHM into a common metric, human milk, despite the marked differences in the composition, efficacy, and associated costs of MOM and DHM. The blurring of MOM and DHM outcomes has significant implications for the targeting of resources that prioritize MOM feedings in the NICU. This article reviews the evidence about fundamental differences in MOM and DHM feedings for VLBW infants during the NICU hospitalization and provides recommendations for practice and research.