In these special cases when the optimal choice of direct breastfeeding is not a possibility, the World Health Organization (WHO) recommends the use of donor human milk, not formula, as the next best option for ensuring exclusive human milk feeding until mother’s own milk becomes readily available via breastfeeding or milk expression. Further, WHO recommends that if donor human milk is needed, then it should be safely provided through a human milk bank (HMB).

While donor human milk cannot provide the full benefits of direct breastfeeding from a newborn’s mother, it is preferable to infant formula due to reduced risk of sepsis, necrotizing enterocolitis, diarrhea, and feeding intolerance, as well as length of stay in critical care.

ESPGHAN Committee on Nutrition; Arslanoglu, Sertac,; Corpeleijn, Willemijn; Moro, Guido; Braegger, Christian; Campoy, Cristina; Colomb, Virginie; Decsi, Tamas; Domellöf, Magnus; Fewtrell, Mary; Hojsak, Iva; Mihatsch, Walter; Mølgaard, Christian; Shamir, Raanan; Turck, Dominique; van Goudoever, Johannes

“Donor Human Milk for Preterm Infants: Current Evidence and Research Directions” (JPGN 2013; 57: 535-542)

Protection against necrotizing enterocolitis is the major clinical benefit deriving from the use of DHM when compared with formula. Limited data also suggest unfortified DHM to be associated with improved feeding tolerance and with reduced cardiovascular risk factors during adolescence. Presence of a human milk bank (HMB) does not decrease breast-feeding rates at discharge, but decreases the use of formula during the first weeks of life. This commentary emphasizes that fresh own mother’s milk (OMM) is the first choice in preterm infant feeding and strong efforts should be made to promote lactation. When OMM is not available, DHM is the recommended alternative.