1 Paediatric and International Nutrition, Department of Nutrition, Exercise and Sports, Faculty of Science, Københavns Universitet2 Division of Neonatology, Izmir Dr Behçet Uz Children's Hospital, Izmir3 Paediatrics, VU University Medical Center, Amsterdam, the Netherlands, and Paediatrics, Emma Children's Hospital-AMC, Amsterdam4 Italian Association of Human Milk Banks, Milan5 University Children's Hospital, Zurich6 Department of Paediatrics, University of Granada, Granada7 Hospital Necker Paris, Paris8 University of Pecs9 Department of Clinical Sciences, Paediatrics, Umeå University, Umeå10 MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London11 Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb12 Department of Paediatrics, Harlaching, Munich Municipal Hospitals, Munich13 Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv14 Jeanne de Flandre Children's Hospital, Lille University Faculty of Medicine, Lille15 unknown16 University of Pecs17 Paediatric and International Nutrition, Department of Nutrition, Exercise and Sports, Faculty of Science, Københavns Universitet
Current evidence and research directions
The Committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition aims to document the existing evidence of the benefits and common concerns deriving from the use of donor human milk (DHM) in preterm infants. The comment also outlines gaps in knowledge and gives recommendations for practice and suggestions for future research directions. 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. When neither OMM nor DHM is available, preterm formula should be used. DHM should be provided from an established HMB, which follows specific safety guidelines. Storage and processing of human milk reduces some biological components, which may diminish its health benefits. From a nutritional point of view, DHM, like HM, does not meet the requirements of preterm infants, necessitating a specific fortification regimen to optimize growth. Future research should focus on the improvement of milk processing in HMB, particularly of heat treatment; on the optimization of HM fortification; and on further evaluation of the potential clinical benefits of processed and fortified DHM.
Journal of Pediatric Gastroenterology and Nutrition, 2013, Vol 57, Issue 4, p. 535-542