Review shows that donor milk does not promote the growth and development of preterm infants as well as maternal milk

Abstract

Aim This nonsystematic review examined differences in the composition of raw maternal breastmilk and pasteurised donor milk and possible health effects on preterm infants. Methods We searched PubMed up to July 2018 for studies published in English that focused on four comparisons as follows: raw maternal milk versus donor milk, human milk before and after Holder pasteurisation, milk from mothers who delivered preterm and at term and milk collected during early and late lactation. We also searched for possible effects of the milk components, as well as the effects of maternal and donor milk on preterm infants’ health. Results Raw maternal milk contained factors involved in antioxidant and anti‐inflammatory defence, gut microbiome establishment and the maturation of immune defences, food tolerability and metabolism. Many of these factors were reduced or abolished in processed donor milk. Both maternal milk and donor milk have been associated with a reduced incidence of necrotising enterocolitis. High‐dose feeding with maternal milk during the neonatal period reportedly reduced the risk of other morbidities and promoted growth and neurodevelopment. Conclusion Many of the components in raw maternal breastmilk were lacking in pasteurised donor milk, which was inferior in promoting the growth and development of very preterm infants.

Donated Human Milk as a Determinant Factor for the Gut Bifidobacterial Ecology in Premature Babies

“…Premature infant care is in continuous progress; however, optimal feeding is still a challenge due to specific requirements and most extremely premature babies suffer postnatal growth retardation [8]. Breastfeeding and human milk are the gold standards for infant feeding and nutrition and are recommended from the first hour of life to the first six months exclusively, with complementary solid foods being introduced up to two years of age or beyond [9].…”

“…Breastfeeding and human milk are the gold standards for infant feeding and nutrition and are recommended from the first hour of life to the first six months exclusively, with complementary solid foods being introduced up to two years of age or beyond [9]. Breast milk contains all the compounds and energy necessary for the correct development and growth of infant during the early stages of life and is associated with the promotion of neurodevelopment, protective effects against necrotizing enterocolitis (NEC), and reductions in late onset sepsis and retinopathy severity in prematurity [8,10].…”

“…In this situation, the WHO recommends using expressed breast milk from donor mothers as a preference to formula milk in premature babies, including healthy but very low birth weight babies until 1 kg [11]. Donor human milk (DHM) is associated with lower incidence of severe gut disorder, NEC, and other infections during initial hospital stays after birth in comparison with formula feeding [8,11]. In hospitals where milk-banking facilities are available and in other external milk banks, DHM is subjected to the holder pasteurization (HoP) process, which involves raising the temperature of human milk to 62.5 • C for 30 minutes to ensure the inactivation of bacteria and viruses [12].…”

“…In hospitals where milk-banking facilities are available and in other external milk banks, DHM is subjected to the holder pasteurization (HoP) process, which involves raising the temperature of human milk to 62.5 • C for 30 minutes to ensure the inactivation of bacteria and viruses [12]. Thus, the HoP process entails modification of the raw maternal milk components such as bacterial and human cells, immunoglobulins, enzymes, proteins, cytokines, hormones, growth factors, and antioxidants [8], but some authors maintain that no modifications occur in the saccharide component [8,13]. Therefore, HoP is still a matter of debate.…”

Highlights in this issue

“…A review by Hård et al. showed that pasteurised donor milk did not promote the growth and development of very preterm infants as effectively as raw maternal milk. Both were associated with a lower incidence of necrotising enterocolitis than preterm formula, but high‐dose feeding with maternal milk also reduced the risk of other morbidities.…”