Donor Human Milk is the next best option
The World Health Organisation (WHO) recommends that when a mother’s own milk is not available, the use of donor human milk is the next best option.
So why is donor human milk recommended for use when a mother’s own milk is not available?
It is superior to cow’s milk formula because it provides human proteins instead of foreign non-human proteins.
It has some immune properties not found in cow’s formula milk.
It has oligosaccharides which are completely retained after pasteurisation, these serve as prebiotics and will help build up the infant’s microbiome.
It is the correct pH for the gut, resulting in better feed tolerance.
There is some evidence that it has a lower risk for necrotizing enterocolitis (NEC) in low-birth weight infants.
Currently there is insufficient evidence of how DHM compares to formula cow’s milk, we base our assumptions on the fact that Mother’s own milk (MOM) compared to formula milk is far superior.
BUT donor human milk is not equivalent to MOM
MOM is personalised for her infant, for example it has antibodies against microbes that her infant will be exposed to – DHM will not have these specific antibodies.
DHM is processed – several freezing and thawing cycles resulting in small losses of nutrients and other important factors.
Pasteurising destroys the lipase enzymes so the lipids (fats) in DHM are not easily digested.
Pasteurising destroys the microbiome of the milk so infant does not develop a normal microbiome in the early weeks of life when it is most crucial.
Therefore, DHM although far superior to formula milk should only be used in special circumstances where a mother’s own milk is not available. The first call for Health Care Workers is to encourage and support mothers to establish their own breastfeeding from the first hour of their infant’s birth.
References:
Reimers P, Coutsoudis A. Donor Human Milk Banking—Time to Redirect the Focus? Journal of Human Lactation. 2021;37(1):71-75. doi:10.1177/0890334420941805
Frequently asked questions
Is donor milk safe to use?
A very through screening of donor mothers is carried out and the milk is pasteurised which kills most viruses and bacteria and it is tested after pasteurisation. It is infinitely safer to use donor human milk than cow’s milk- based formula milks which can easily become contaminated and can cause severe disease especially in low- birthweight infants.
Does donor milk have sufficient energy/calories for preterm infants?
Every effort is made to give preterm infants donor milk expressed from mothers of a preterm infant, to ensure it is closely matched to the recipient requirements. If not, term milk is used which is still preferable to using artificial substitutes.