Using Donor Milk in the NICU

Rationale

Research shows that all babies, especially ill or preterm ones, need human milk to thrive. Passive immunity through secretory IgA and other immune factors naturally found in the milk protects against infectious bacteria and viruses, while epidermal growth factor and oligosaccharides may help mature the intestinal tract. Composition of human milk changes over time to help meet the infant’s needs at different developmental stages.

The combination of these factors has shown to protect against problems such as NEC, URI, sepsis, and long term protection against obesity, diabetes, and food allergies. A mother’s own milk is optimal for her baby under most circumstances. The American Academy of Pediatrics specifically recommends for preterm infants “if the mother’s milk is unavailable or contraindicated, donor human milk is a suitable alternative”.

Policy

  • A healthcare provider must order donor human milk.
  • The family of the neonate should be made aware that human donor milk is being used. MMBNE recommends that informed consent be obtained, with individual hospital policy determining content.

Guidelines for NICU distribution

  1. Preterm birth or small for gestational age
  2. Feeding intolerance
  3. Post-surgical nutrition (e.g., PDA ligation, bowel surgery, NEC)
  4. Malabsorption syndromes
  5. Short-gut syndrome
  6. Fetal distress/hypoxia as evidenced by low apgars
  7. Renal failure
  8. Cardiac problems
  9. Bronchopulmonary dysplasia
  10. Inborn errors of metabolism
  11. Immune disorders

Procedure for obtaining milk

  1. The healthcare provider will discuss the risks and benefits of the use of donor human milk with the family or guardian, and obtain a signature of consent if required by the hospital.
  2. Once a healthcare provider has requested DHM for a patient, the steps detailed in our “Ordering Donor Milk” page should be followed. If possible, orders should be placed at least 24 hours in advance. Our normal ship day is Wednesday for orders placed by Tuesday afternoon. Rush orders can be accommodated on any business day for an additional charge.