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5 Donor Human Milk Tales: How to Make an Informed Decision for Your Hospital




Providing donor human milk (DHM) to infants in your hospital is a step in the right direction to improve outcomes. After all, it will support exclusive human milk feeding when mother’s own milk (MOM) is either not available or is in limited supply.

The American Academy of Pediatrics (AAP) recommends donor milk over artificial milk. The AAP states the advantages of human milk feeding include a reduction in occurrence of not just necrotizing enterocolitis (NEC), but also sepsis and mortality.

That recommendation, along with countless research, supports the use of donor milk – especially for at-risk and premature infants.

Unfortunately, the circulation of “old wives’ tales” and misinformation builds a barrier to best practices data and understanding the scientific scope of donor milk. Healthcare professionals are seeking answers to best serve their patient population, only to be confronted with that barrier.

Five specific topics, or tall tales, are quite often the culprits causing problems.

We’ve outlined five common questions and presented the good news that these tall tales are just not true.

#1: Will providing donor milk prevent mothers from breastfeeding later?

The short answer is, thankfully, no.

A mother’s own breast milk is the best possible nourishment for her infant. Unfortunately, not all mothers can provide breast milk due to a variety of factors.

It may seem counterintuitive to provide DHM to infants while mothers are unable or limited in providing their own, and still plan to do so later. After all, wouldn’t the act of providing donor milk feedings early on either prevent or discourage moms from continuing efforts to produce their own?

The good news: It’s just not true.

Alyahya et al explored the impact of offering DHM to NICU infants and eventual MOM availability. Their findings indicate offering DHM to preterm neonates did not affect subsequent MOM availability.1

Additionally, Belfort et all explored the outcome of MOM in the well-baby nursery when DHM was offered in first feeds. They found the use of DHM in healthy infants did not have a negative impact on MOM. In fact, offering DHM was associated with higher exclusive breastfeeding at discharge.2

#2: Is donor milk fresher when delivered direct from a milk bank?

The idea that donor milk from a local milk bank is the freshest compared to other options is understandable. Yet it only holds up until you consider all moving parts necessary to meet safety and food processing standards. The FDA has defined “fresh” and “fresh frozen” and clearly all sources of donor milk can truthfully make this claim.

All donor milk must be properly sterilized or pasteurized before distribution. Often there are pre-screening steps involved with the pooled donor milk before pasteurization occurs (although not all milk banks conduct these steps). Ultimately, the time involved includes:

  • Testing

  • Preparing

  • Sterilizing/Pasteurizing

  • Testing again

  • Storing

  • Packaging

  • Freezing

  • Distribution

All these steps add up to be as time intensive as any other donor milk process and all are equally “fresh” based on the FDA regulations on labeling

#3: Do research studies use the exact sterilization or pasteurization methods that donor milk companies use?

Without a doubt, human milk and donor milk research has paved the way to understanding its incredible medical potential. Healthcare for infants would not be where it is today without such groundbreaking work.

However, donor milk research to purposely discredit valuable methods does exist.

Occasionally competitive milk banks conduct research on rival methods and report outcomes not based on the actual process that donor milk company uses. Instead, proprietary processes are guessed at, and inaccurate outcomes about bacteria and nutritional content are reported as factual.

We urge readers to verify the source of the studies they read, to consider the impact the publisher intends, and to ask questions about variables used in the study.

#4: Does freezing donor milk preserve more nutrients?

A common pooled donor human milk pasteurization method is Holder Pasteurization (HoP), which requires milk to be frozen for storage after pasteurization occurs. A tall tale sometimes shared includes the idea that freezing preserves nutrients. It is clear that freezing does not do so after reviewing the evidence.

Garcia-Lara et all conducted research on the HoP method followed by freezing, and its impact to milk components and nutrients. They found the HoP process decreased fat and energy content of human milk. It’s worth mentioning here that any pasteurization or sterilization method will have some small impact to the nutrients. The point here, however, is they found frozen storage significantly reduced fat, lactose, and energy content.3

That is why more and more donor milk companies pursue improved methods of not only sterilization, but also establishing a shelf-stable donor milk product which can be delivered without the denaturing (or bacterial risk) effects of freezing and thawing.

#5: Is Holder pasteurization (HoP) the best method for donor milk?

HoP is a traditionally used method for human milk processing and has been in use for nearly 100 years. An article in the International Milk Genomics Consortium states, “Overall, then, HoP does a good job and eliminating the vast majority of the infectious agents that can, in theory, contaminate milk.” Of course, microbial standards for raw milk must fall below recommended levels. If the microbial levels are too high, HoP will not be effective.

It is essentially an accepted practice. But it has limitations – primarily the inability to eliminate excessive levels of bacteria, heat-resistant bacteria, and spores. Such bacteria can easily find itself thriving in the final HoP product if a milk bank does not perform pooled milk pre-screening. One such bacteria is B. cereus, a nasty little critter which can have devastating and sometimes fatal health consequences to a preterm or at-risk infant.

Landers et al found that as much as 7% of HoP donor milk showed growth on routine bacterial cultures.4

Some donor milk companies have taken commercial sterilization (such as Retort sterilization) science to a new level and championed advanced sterilization methods. These methods retain the valuable nutrition components in donor milk while eliminating heat-resistant bacteria that can survive traditional HoP pasteurization methods.

As new technology and research evolves, it cannot be said that HoP is the best method. At present it is only the most common due to its long-accepted process.

Avoid donor milk tales

The donor milk industry serves a higher purpose. That purpose is to provide established benefits of human milk to as many infants as possible for improved health outcomes.

Clinical professionals want to provide it for exactly that reason.

When reviewing options for DHM into your hospital to serve your smallest patients, be sure to ask questions, explore the options, and provide the best resource you can. And avoid those tall tales!

Learn more about shelf-stable Medolac donor milk Benefit Human Milk products.

Looking for more information about the benefits of donor milk? Read the NEC in the NICU: The Impact of Human Milk infographic.

References:

1. Alyahya et al (2019). Donated human milk use and subsequent feeding pattern in neonatal units. International Breastfeeding Journal 14, Article number 39.

2. Belfort et al (2018). Prevalence and trends in donor milk use in the well-baby nursery: A survey of northeast united states birth hospitals. Breastfeed Med. Jan/Feb 2018;13(1):34-41. doi: 10.1089/bfm.2017.0147. Epub 2017 Oct 24.

3. Garcia-Lara et all (2013). Effect of holder pasteurization and frozen storage on macronutrients and energy content of breast milk. J Pediatr Gastroenterol Nutr. Sep;57(3):377-82. doi: 10.1097/MPG.0b013e31829d4f82.

4. Landers et al (2010). Bacteriological screening of donor human milk before and after holder pasteurization. Breastfeeding Medicine. Jun;5(3):117-21. doi: 10.1089/bfm.2009.0032.

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