Donor milk and milk banks

What are milk banks and pasteurized donor human milk?

Pasteurized donor human milk, commonly shortened to DHM, is breast milk donated to milk banks by breastfeeding mothers who can express and have enough milk for their own babies. The milk banks test the milk, pool, and pasteurize it. It is recommended for premature or vulnerable babies when the mother’s own milk is not available. Premature babies who receive DHM instead of infant formula have fewer infections and other serious diseases. The use of DHM has grown quickly, but not all hospitals provide it, despite its benefits and cost-effectiveness.

A) Pasteurized donor human milk

Pasteurized donor human milk, commonly shortened to DHM, is breast milk that is donated to milk banks by mothers who:

  • Can express.
  • Have enough milk for their own babies.
  • Meet the criteria for donations.

Milk banks pool donor milk to minimize variation among samples (John 2019). They also test it and then pasteurize (heat) it to kill any microbes. This affects a range of DHM's components. DHM is stored by freezing and then transported to where it will be used.

The mother’s own milk is always the preferred milk for vulnerable hospitalized babies. Mothers benefit from extra support in establishing and maintaining their milk in such situations.

DHM from a milk bank is the second best milk and much preferred over infant formula (AAP 2016; Hård 2018; Kim 2010).

DHM and milk banks should be part of an integrated approach to providing the best care and nutrition for babies and support and guidance for mothers (DeMarchis 2017; Drouin 2019).

Mothers may worry about DHM being obtained from mothers with older babies. There is no evidence that premature babies do better when given DHM from mothers of preterm babies compared to DHM from mothers of older babies (Dempsey 2019).

B) Advantages of pasteurized donor human milk over infant formula

1) Benefits for premature babies

Necrotizing enterocolitis is a severe disease of the bowel seen in premature and newborn babies. It causes high death rates and lifelong consequences for survivors. Babies who receive DHM instead of infant formula are less likely to develop this (Lu 2019; Quigley 2019).

Premature babies who receive DHM instead of infant formula (Miller 2018):

  • Have fewer blood infections (sepsis) and other serious infections (Kim 2017).
  • Have less chronic lung disease (bronchopulmonary dysplasia) (Kim 2017; Villamor-Martínez 2018).

As they are less likely to get sick, premature babies who are given donor milk instead of infant formula incur fewer costs while in hospital (Zanganeh 2021).

2) Benefits for other babies

There is limited research to support the use of DHM in babies other than premature ones but this does not rule out benefits (McCune 2020)Several studies have shown babies with health challenges have improved digestion and gut health (McCune 2020).

C) Advantages of mother's own milk over pasteurized donor human milk

Mother’s own milk is preferred to DHM, which is less bioactive (Neu 2019; Peila 2016; Perrin 2020; Riskin 2020).

It is less able to protect the baby from illness-causing bacteria as it:

  • Does not contain active stem cells or white blood cells.
  • Has lower levels of antibodies and other immune system helpers (Arroyo 2017).
  • Has lower levels of the enzyme lysozyme, which breaks down harmful bacteria (Paulaviciene 2020).  
  • Has lower amounts of lactoferrin.

Donor human milk does less to encourage a healthy gut bacteria (microbiome) as it (Cai 2019; Ford 2019; Parra-Llorca 2018; Zanella 2019):

  • Results in less diverse gut bacteria.
  • Allows more growth of harmful bacteria.
  • Has different amounts and types of human milk oligosaccharides.

Donor human milk:

  • Is less protective against necrotizing enterocolitis.
  • Has less anti-oxidant strength (Păduraru 2018).

It may affect the baby’s nutrition as it:

  • Has lower levels of certain vitamins including vitamin C and B6 (Van Zoeren-Grobben 1987).
  • Has lower levels of several digestive enzymes.
  • Has no active lipase enzyme to help fat digestion.

 Donor human milk can affect long-term growth and development as it:

  • Has lower levels of agents (alkaline phosphatase; cytokines) that help reduce excess inflammation.
  • Has reduced levels of hormones that encourage growth (Vass 2020).
  • Has different genetic material.
  • Has lower levels of microRNA (Smyczynska 2020).
  • Results in babies with poorer weight and length gains (Brownell 2018; de Halleux 2019; Ford 2019; Lloyd 2019; Lund 2019).

Very small or premature babies may not grow as quickly in the short term when given unfortified donor milk when compared to those given infant formula (Lu 2019; Quigley 2019). There is no evidence of a difference in long-term growth or brain development (Lu 2019; Quigley 2019).

D) Getting pasteurized donor human milk

Most families get DHM through their hospitals. The amount distributed in North America has dramatically increased: from 14,790 litres (500,000 U.S. fluid ounces) in 2000 to 170,050 l (5.75 million oz) in 2017 (HMBANA). However, not all hospitals provide DHM (Boundy 2017; Klotz 2020; Parker 2020; Perrin 2018).

There can be barriers to using DHM. A milk bank or other facility may not be available to obtain, pasteurize, and test human milk. Transportation may be limited or costly and hospital staff time is needed to prepare DHM and discuss its use with families.

Some hospitals and governments are reluctant to pay for DHM (Daili 2020). However, the cost of using DHM from a milk bank and using it is less than the cost of caring for babies who are sick as a result of infant formula use (Buckle 2017; Trang 2018).

Milk banks usually give out DHM only to premature or sick babies because there is a limited amount and they focus on the most vulnerable babies. Some babies received DHM for the first few days after birth until the mother's milk comes in. Occasionally, mothers of children with a chronic illness maybe able to buy milk from a milk bank, but it is very expensive over time.

Standards can vary between milk banks (Sachdeva 2019).

E) Milk siblings

There is a tradition of milk kinship in Muslim families. The sharing of breast milk between a mother and another mother’s child results in a family relationship. The mother’s own children and the non-birth child become milk-brothers and milk-sisters and are not allowed to marry. Therefore, anonymous donations may not be acceptable to the family and milk banks are generally not found in Muslim countries (Subudhi 2021).   

Donor milk may be more acceptable if the number of donors per baby are limited, there is a registry of donors and recipients, or the donor and the recipient family meet, discuss religious implications, and complete consent forms (Alnakshabandi 2016; Ghaly 2018; Khalil et al. 2016; Subudhi 2021).

Please discuss any concerns with your health-care providers. 

References

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