Why use pasteurized donor human milk (PDHM)?
PDHM is safe, effective, and it saves lives. The clinical benefits of PDHM are well documented and the use of PDHM is endorsed by professional organizations and experts in the field.
• Surgeon General: “Growing evidence supports the role of donated human milk in assisting infants with special needs, such as infants in newborn intensive care units who are unable to receive their own mothers’ milk, to achieve the best possible health outcome.”1
• WHO/UNICEF: “Where it is not possible to breastfeed, the first alternative, if available, should be the use of human milk from other sources. Human milk banks should be made available in appropriate situations.”2
• American Academy of Family Physicians: “Banked pasteurized donor human milk has been found to be safe and nutritionally sound for babies who do not have access to their own mother’s milk.”3
• AAP: “Banked human milk may be a suitable feeding alternative for infants whose mothers are unable or unwilling to provide their own milk. Human milk banks in North America adhere to national guidelines for quality control of screening and testing of donors and pasteurize all milk before distribution.”4
Is donor milk safe?
The Mothers’ Milk Bank of the Western Great Lakes ensures the safety of its pasteurized human donor milk (PDHM) by following screening, processing, and dispensing guidelines established by the Human Milk Banking Association of North America (HMBANA). (For more information, see http://www.hmbana.org/index/missiondescription.) Mothers with extra milk and a desire to donate provide health and lifestyle histories, and undergo blood tests, similar to the screening process used at blood banks. Mothers are blood tested for HIV 1 & 2, Hepatitis B, Hepatitis C, HTLV 1 & 2, and Syphilis. Mothers also need to obtain medical clearance from their physician. Donated milk is pasteurized, which destroys many bacteria and viruses, including HIV and CMV.5 Before the pasteurized milk is dispensed, bacteriological testing is done to ensure its safety. There has never been a reported case of HIV transmission with the use of PDHM in the United States.5
What is the history of human milk banking in the United States?
In 1911, Dr. Francis Denny of Boston’s Floating Hospital for Children created a milk bank to combat the “summer sickness” that so many babies of the time succumbed to. Summer sickness, or diarrheal disease, was a major cause of infant mortality caused by contaminated water and animal milk. Dr. Denny’s milk bank provided infants with donor human milk in the absence of their own mother’s milk.6 Several milk banks developed around the country in the years that followed. In 1985, the Human Milk Banking Association of North America (HMBANA) was established to provide evidence-based guidelines and standards for the industry. Today, there are 9 operating HMBANA milk banks in the United States. These milk banks operate for the same reason they did 100 years ago, to improve infant outcomes and save lives.
How do premature or sick infants benefit from donor milk?
Human milk is the nutritional gold standard for all infants, and especially premature infants. Human milk protects against NEC7-10, sepsis11, and is even correlated with a reduced length-of-stay in the NICU9. 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. This nutrient rich milk is easily digested by the premature infant. In many cases, the tiny premature gut simply cannot tolerate formula feedings. Premature infants who are fed human milk experience fewer episodes of feeding intolerance12 and attain full enteral feedings earlier than their formula fed counterparts13. Mothers of premature infants know how important their milk is. However, many struggle to establish or maintain a full supply. In fact, preterm mothers are about 3 times more likely to have a low milk supply than term mothers14. In the absence of mother’s milk, pasteurized donor human milk (PDHM) is needed. PDHM provides many of the same protections as mother’s milk. A recent systematic review and meta-analysis concluded that pasteurized donor human milk reduces the risk of NEC by 79%12. Exclusive human milk feedings, utilizing PDHM are an essential component of any NICU nutrition program.
“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.”15
Is human milk still beneficial after being pasteurized?
When human milk is pasteurized via Holder method, the milk is heated to 62.5 degrees C for 30 minutes in a shaking water bath. We know that several immunological factors become less active in this process, including lysozyme, lactoferrin, lactoperoxidase, and secretory immunoglobulin A.16 However, oligosaccharides are not affected by the pasteurization process.17 Oligosaccharides play very important prebiotic, immunomodulatory and antimicrobial roles in infants. Other immunologic and growth factors also retain activity after pasteurization, such as epidermal growth factor, and transforming growth factors (TGF). Some TGF subtypes have an anti-inflammatory effect upon fetal intestinal cells, which may help to decrease NEC.18
1 U.S. Department of Health and Human Services. (2010). Surgeon General’s call to action to support breastfeeding.
2 World Health Organization/United Nations Children’s Fund. (1980). Meeting on infant and young child feeding. The Journal of
Midwifery and Women’s Health, 25, 31-38.
3 American Academy of Family Physicians. (2008). Family physicians supporting breastfeeding [Position Paper].
4 American Academy of Pediatrics. (2005). Breastfeeding and the use of human milk [Policy Statement]. Pediatrics, 115(2), 496-506.
5 Human Milk Banking Association of North America. (2009). Guidelines for the Establishment and Operation of a Donor Human
Milk Bank. Raleigh, NC: HMBANA.
7 Lucas, A. & Cole, T. J. (1990). Breast milk and necrotizing enterocolitis. Lancet, 336. 1519-1523.
8 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.
9 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.
10 Sisk, P. M., Lovelady, C. A., Dillard, R. G., Gruber, K. J., & O’Shea, T. M. (2007). Early humanmilk feeding is associated with a lower risk of necrotizing enterocolitis in very low birthweight infants. Journal of Perinatology, 27, 428-433.
11 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
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 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
14 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.
15 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.
16 Akinbi, H., Meinzen-Derr, J., et al. (2010). Journal of Pediatric Gastroenterology and Nutrition, 51, 347–352.
17 Bertino, E., Guiliani F., et al. (2009). Early Human Development. 85, S9–S10
18 Ontalan P., Keeney S.E., et al. (2009). Heat susceptibility of interleukin-10 and other cytokines in donor human milk. Breastfeeding Medicine. 4(3), 137-144.