Donor human milk helps extremely vulnerable hospitalized infants in the neonatal intensive care unit (NICU). It supports the infant’s immune system and is easier to digest than formula.
Physicians may prescribe donor human milk for hospitalized, low-birth-weight infants. Each hospital follows its own eligibility guidelines.
Who can get donor human milk?
Infants must meet the following conditions to receive donor human milk:
- Completion of a discussion between the parent(s) or guardian(s) and the physician, nurse practitioner or dietitian about the risks and benefits of using pasteurized donor human milk
- Written consent from the parent(s) or guardian(s) to use donor human milk, obtained by a member of the health-care team, before dispensing
- Donor consent, filed in the patient’s chart
- An order for donor human milk feeding, documented by prescription under the “Doctor’s Orders” section of the patient’s chart
How do I order donor human milk for my hospital?
For information on ordering donor human milk for your hospital, email the Ontario Human Milk Bank.
Donor human milk feeding guidance
- With prior consent, pasteurized donor human milk can be thawed and shared between infants in the NICU
- Donor human milk and its added nutrients must be prepared the same way as the NICU prepares their parent’s own milk
- Clinicians should add extra nutrient fortification if needed, watch growth closely and add nutrients if weight gain falls below expectations
- How long a baby is eligible to receive donor human milk depends on how early they were born
- Infants receiving donor human milk should be weaned during the final three days of use or before going home
- During this stage, the baby should be provided with their parent’s milk when available
- Other feedings should be a one-to-one mix of donor human milk and preterm formula for two or three days
- After that, only infant formula should be used as a supplement
- Record the donor human milk batch number and the date it was dispensed in the patient’s permanent hospital chart
Nutritional analysis of donor human milk
Pasteurizing donor human milk safely removes potentially harmful bacteria while keeping the core nutrients that infants need largely intact. Although some proteins and immune factors are reduced during the process, pasteurized donor human milk still delivers reliable nourishment and many beneficial elements for growing infants.
Effect of the pasteurization process on human milk components
Source: O’Connor DL, Ewaschuk JB, Unger S. Human milk pasteurization: Benefits and risks. Curr Opin Clin Nutr Metab Care 2015;18(3):269-75.
| Component | Maintained (>90%) | Maintained (50-90%) | Maintained (10-50%) | Abolished (<10%) |
|---|---|---|---|---|
| Macronutrients | Carbohydrate (Lactose, Oligosaccharides) | Protein Total fat | ||
| Micronutrients | Calcium Copper Magnesium Phosphorus Potassium Sodium Zinc | Iron | ||
| Vitamins | Vitamin A | Folate Vitamin B6 Vitamin C | ||
| Biologically active (immune) | IL-8, IL-12p70, IL-13 TGF-α | IgA, sIgA IgG IGF-1, IGF-2, IGF-BP2,3 IFN-g IL-1β, IL-4, IL-5, IL-10 TGF-β Gangliosides | CD14 (soluble) IL-2 Lactoferrin-iron binding capacity Lysozyme | IgM Lymphocytes |
| Biologically active (metabolism) | Epidermal growth factor Heparin binding growth factor | Adiponectin Amylase Insulin | Erythropoietin Hepatocyte growth factor | Bile-salt stimulated lipase Lipoprotein lipase |
Bioactive components are affected to varying degrees by Holder pasteurization; some remain intact, while cellular components are completely abolished. Ig, immunoglobulins; IGF, insulin-like growth factor; IFN-g, Interferon-g; IL, interleukin; TGF, transforming growth factor.
Using donor human milk: Frequently asked questions
Open All- Illness or delivery complications are delaying the milk supply
- Not enough milk supply when pumping for multiples (for example, twins)
- Stress from having a hospitalized or sick baby
- Not getting natural hormone signals because the baby cannot feed directly
- A chronic infection or medical condition that prevents milk expression
- An infection that is temporarily affecting milk production (for example, mastitis)
- Geographic separation from the baby
Yes. Donor human milk is provided free of charge to eligible hospitalized infants by prescription.
Yes. Donor human milk is very safe. For decades, no cases of disease have been linked to donor human milk, similar to blood products. Pasteurization (heat treatment) kills any microorganisms in the milk.
Parents from different religions may have unique beliefs about feeding their newborns. This might raise questions about using donor human milk. If you have concerns about diet or your faith, it is a good idea to talk to your baby’s physician or your spiritual or religious leaders for guidance.
Families of the Jewish faith:
Jewish law recognizes the importance of donor human milk. For infants born preterm or who are medically fragile, donor human milk provides the nutrition they need and helps keep them safe from severe health problems.
Families of the Islamic faith:
In Islam, using donor human milk raises questions about whether it connects the baby’s family and the donor’s family. In 2004, respected religious scholars, supported by the European Council of Fatwa and Research, spoke on this topic. They agreed that human milk banks are a good idea because they help preterm infants, which is important in Islam. They ruled that there are no religious rules against using milk banks or donor human milk, and that feeding a baby this way does not create a family bond. Here are the reasons for this decision:
- The concept of suckling, which creates a bond like family ties, needs some clarification. In the Qur’an, there is a verse that lists relatives a person cannot marry, which includes “…your mothers who have suckled you and your foster sisters” [Su¯rat al-Nisa¯’ 04:23]. This verse talks about “motherhood” and “suckling,” which means more than drinking milk from someone. For a real family bond to form, suckling has to happen with close contact between the baby and the parent. If a baby gets milk through a feeding tube or a bottle, that does not count as suckling and will not create a family tie. Also, getting milk from a donor is not the same as having a foster mother, as described in the Qur’an. Most Muslim scholars agree that there is no proof that getting milk from an anonymous donor is haram (forbidden).
The identities of the parents who donate milk and how much they give are not known. Each batch of donor human milk usually comes from three to five different donors. This means that a baby doesn’t receive milk from just one donor, which makes it difficult to feel a connection or sense of family with them. Since the donors are anonymous and we do not know how much each one gives, it does not create that kind of special bond.
Islam is a religion that values the health and well-being of children and makes sure not to put too much stress on its followers. The protective health benefits of donor human milk for medically fragile infants are a strong reason for its use.
Families with vegan or vegetarian diets:
Some families who follow a vegan or vegetarian diet may have additional questions about the diets of donors.
Each batch of donor human milk is usually a blend from three to five donors, carefully combined to support consistent nutrient content. The Milk Bank screens whether donors’ diets are adequate, but we do not have batches of donor human milk from donors who are only vegan or only vegetarian.