Benefits of Donor Breast Milk in Special Care Nursery 

By Judy Ross, Manager Maternity Services at Gold Coast Private Hospital

Premature infants are infants born before 37 weeks gestation and Healthscope Special Care Nurseries accept babies born from 32 weeks gestation. These premature infant are born with extremely immature immune systems which enhances their risk of infection and intestinal complications.  Breastmilk is the ideal source of nutrition and provides immunity and protective properties that will assist the premature infant during this critical time while the gut learns to tolerate milk. The premature infant has decreased coordination of the suck reflex to breast or bottle feed requiring enteral feeding via nasogastric tubes. They often need greater volumes of breastmilk than the mother can produce until her milk supply is established in the first few days. Registered milk banks have been successfully established in Australia providing neonatal units with pasteurized donor breastmilk, Mothers Milk Bank is one of these Units.

Donor breastmilk from a registered milk bank is available for premature infants worldwide in tertiary hospitals, with limited availability in Healthscope Hospitals Special Care Nurseries.   There is increasing evidence to support the use of donor breastmilk to supplement premature infants enteral feeding while the mother is establishing her own supply. At Gold Coast Private Maternity Unit, donor breastmilk is available as an alternative to artificial feeds, such as infant formula, for premature infants. The priority is to continually support mothers to express breastmilk for their premature infant while requiring enteral feeding. The availability of donor breastmilk to be provided to supplement is well supported by mothers and paediatricians in the Special Care Nursery.  

While each mother’s own expressed milk is specifically designed to meet the needs of her own baby, whether born prematurely or at term, the composition changes to meet individual requirements. The introduction of donor breastmilk will enable the mother to have the opportunity to supplement her infant with the optimal source of nutrition till her milk supply is established.  Donor breastmilk will benefit the premature infant in many ways. These include decreased risk of gastrointestinal complications due to the immaturity of the infant’s gut metabolism, reduced risk of infections and necrotizing enterocolitis (NEC). The long-term benefits of breastmilk include improved neurodevelopmental outcomes for the premature infant. While artificial formulas are designed to meet the growth and energy requirements of the premature infant, they do not have the unique properties that are found in human breastmilk. While infant formulas can significantly increase the premature infant’s weight and meet their nutritional requirements, they can increase the risks of necrotizing enterocolitis in the premature infant. The introduction of pasteurized donor breastmilk from a registered milk bank is superior to artificial formula in reducing the incidence of necrotizing enterocolitis and other gastrointestinal complications. Infant formula, while a cheaper option to donor breastmilk, is mainly made of casein proteins which can form a rubbery curd mass in the premature infant’s stomach and are more difficult to digest. Breastmilk is made of curds and whey that are more readily digested.

Registered milk banks ensure that breastmilk donors have undergone a rigorous screening process prior to being able to donate their breastmilk. Milk banks in Australia are the safest in the world and highly regulated. Prior to women donating their breastmilk, a health history and lifestyle questionnaire is completed, pathology testing for viruses and infections including Human Immunodeficiency Virus 1 and 11, Hepatitis B and C, Syphilis and Leukemia type viruses HTLV 1 and 11. Breastmilk is a critical component and the optimal choice of milk for premature infant’s health due to the impact of formula on the premature infant’s immature gastrointestinal tract. 

Approximately 90% of all cases of necrotizing enterocolitis are premature infants every year worldwide, and more than twenty million infants are born prematurely. These infants have increased risk of infectious disease, developmental delay and growth restriction .The World Health Organization recommends that premature infants be fed with breastmilk only and, if there is insufficient mother’s breastmilk, then donor breastmilk from a registered milk bank should be used. While breastmilk contains specific properties such as immunoglobulins and lactoferrin that will promote intestinal adaption, it is more suited to the premature infant with beneficial results in improved enteral feed tolerances and protection against infection and inflammatory disorders. 

A 2007 Cochrane systematic review found that premature infants who received infant formula were approximately 2.5 times at greater risk of developing complications such as necrotizing enterocolitis than the infants who received breastmilk or donor expressed breastmilk. Research has consistently proven that breastmilk is the best form of nourishment for babies and beneficial to their health in the short, medium and long term. It is recognized in Special Care Units throughout Australia to encourage and support mothers to express their own breastmilk to feed their infants but donor breastmilk is required to supplement the mother’s own breastmilk until her breastmilk can be established.