Impact of NICU Donor Human Milk Nutrition On NEC and Feeding Intolerance

Mother’s own milk (MOM) is a superior source of nutrition for infants, especially those most at-risk due to premature birth or complications. But what can you do in the NICU to support best nutrition practices if MOM is not available or in limited supply? Recommendations would point to donor human milk (DHM) to meet exclusive human milk feeding guidelines. Yet that can become confusing when infant formula seems to support increased growth rates.

Infant formula feeding research indicates increased growth rates over MOM or DHM feeding. Formula-fed infants experience accelerated time to regain birth weight, weight gain, linear growth, and head circumference growth over their human milk-fed peers (1). That alone is impressive and speaks to the gains it can provide. However, while infant formula does have its benefits, it lacks important disease-fighting nutrients and gastrointestinal advantages.

Let’s take a closer look at formula versus donor human milk when considering two issues most NICUs strive to avoid: Necrotizing enterocolitis (NEC) and feeding intolerance.

Human milk impact to necrotizing enterocolitis

NEC is a terrible disease with long reaching and dangerous impacts to premature infants. As bacteria invades the gut, it leads to inflammation and infection. The wall of the bowel is then at risk for perforation, along with tissue disease and necrosis.

Mortality risks increase as the disease progresses. NEC occurs in nearly 10% of premature infants. NEC Society reports that 9,000 infants in the United States will develop NEC each year, and 3,600 will die. It is imperative to prevent this disease from taking hold.

NEC incidence and outcomes are quite a contrast when comparing human milk/donor human milk feeding versus formula feeding:

  • NEC often develops within the first two weeks of life in premature infants being fed formula as opposed to breast milk (2)

  • Formula-fed infants have a statistically significant higher incidence of NEC compared to infants fed donor breast milk (1)

  • Donor human milk reduces the risk of NEC by 79% (3)

Human milk impact to feeding intolerance

Feeding intolerance (FI) may be attributable to immaturity of gastrointestinal function, especially for infants born very preterm. FI is essentially an inability to digest enteral feedings and is often accompanied by an increase in gastric residuals, abdominal distention, temperature instability, and bloody stools or water-loss stool. It can lead to suboptimal nutrition and a delay of full enteral feeding (4).

It is important to achieve full enteral feeding to avoid not only the risks, but also the costs, associated with parenteral nutrition. Parenteral nutrition carries risks for infection due to intravascular device delivery as well as metabolic complications. Full enteral feeding supports growth and development optimization while removing parenteral nutrition delivery infection risk. Such optimization accelerates gastrointestinal physiological maturity and the ability to attain nutrient intake and also increase gastric emptying time (5).

When comparing donor human milk and infant formula, it becomes clear which supports full enteral feeding, optimal nutrition, and gut maturation:

  • Formula fed infants have a statistically significant higher incidence of feeding intolerance over donor breast milk-fed groups (1)

  • Human milk enhances gastric motility, stimulates gastrointestinal growth, and protects gastrointestinal mucosa (6)

  • There is a significant reduction of stay in donor human milk groups over the infant formula groups (7)

  • Donor human milk feeding demonstrates a reduction in diarrhea (8)

Donor milk is ideal for preterm infants in the NICU

While formula can support neonatal growth, it cannot provide the wide-ranging positive and disease fighting impacts of donor milk nutrition.

DHM has repeatedly shown its positive influence on preterm infant gut maturation and reduction of feeding intolerance when compared to formula-fed infants. Donor milk has also been shown to reduce the occurrence of NEC, a disease that will take the lives of 15% of babies who get it, and leave lasting complications such as poor growth, short bowel syndrome, and more for those who survive it. And the benefits of DHM over formula go well beyond these highlights, into reduction of sepsis, mortality, and more.

It’s time to make donor milk a priority over formula in all NICUs. These infants deserve every opportunity for a full, healthy life ahead of them – and you can make it happen.

The Medolac Benefit donor milk nutrition portfolio is the only human milk-based nutrition that meets recommendations for commercially sterile replacement feeding in the NICU. Learn more about this shelf stable donor milk resource and the NEW human milk-based fortifier, Fortify MPV.


1. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD002971. DOI: 10.1002/14651858.CD002971.pub3.

2. Children’s Hospital of Los Angeles. Necrotizing Enterocolitis. Accessed online July 23, 2021.

3. Boyd CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2007;92:F169-F175.

4. Fanaro S. Feeding intolerance in the preterm infant. Early Hum Dev. 2013 Oct;89 Suppl 2:S13-20. doi: 10.1016/j.earlhumdev.2013.07.013. Epub 2013 Aug 17. PMID: 23962482.

5. Walsh, V., Brown, J., Copperthwaite, B. R., Oddie, S. J., & McGuire, W. (2020). Early full enteral feeding for preterm or low birth weight infants. The Cochrane Database of Systematic Reviews, 2020(3), CD013542.

6. Edwards, Taryn, & Spatz, Diane L. Making the case for using donor human milk in vulnerable infants. Lippincott Nursing Center. Accessed online July 23, 2021.

7. Yang, R., Chen, D., Deng, Q. et al. The effect of donor human milk on the length of hospital stay in very low birthweight infants: a systematic review and meta-analysis. Int Breastfeed J 15, 89 (2020).

Heiman H, Schanler RJ. Benefits of maternal and donor human milk for premature infants. Early Hum Dev. 2006;82(12):781-787