Using donor milk in the NICU

Rationale

Immunologically, nutritionally, and biologically, species-specific breast milk has been proven to be optimal for all babies, and especially necessary for the preterm or ill infant. Passive immunity through secretory IgA and other immune products 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 needs of even the preterm infant. The combination of these factors has shown to protect against problems such as NEC, URI, sepsis, obesity, diabetes, and food allergies. A mother’s own milk is optimal for her baby under most circumstances. But when unavailable or undesirable, 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. MMBA recommends that informed consent be obtained, with individual hospital policy determining content.
  • A log of the distribution of donor human milk will be maintained by the NICU staff and shared with the Mothers’ Milk Bank at Austin.
  • Problem sheets will be created, as necessary, and transmitted to MMBA for follow-up.

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 physician 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. The physician will write an order for 20Kcal/oz donor human milk, or for 22 or 24 Kcal/oz. donor human milk as appropriate for the infant. 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. Orders requiring shipping are ideally placed by Tuesday for Wednesday shipping and Thursday arrival.