Breastfeeding Medicine

Physicians blogging about breastfeeding

AAP New Policy Statement on Donor Human Milk for the High Risk Infant

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While the birth of neonatology was in the late 1800s with the development of the incubator, it was only in the 1970’s when the modern NICU was established with the neonatal respirator. More advanced respirators and other technologic developments, including important medications such as surfactant and nitric oxide, have dramatically improved the outcome of preterm infants. Yet, one of the most important “new developments” to improve the care of these infants, is feeding an exclusive human milk diet. It is now clear that exclusive breastmilk decreases preterm mortality and the incidence of necrotizing enterocolitis, sepsis, BPD and ROP, while increasing infant brain volume and neurodevelopment in infancy, childhood and adolescence. 

Therefore, it is noteworthy that three AAP committees, the Committee on Nutrition, the Section on Breastfeeding and the Committee on Fetus and Newborn, the committee that writes policies for neonatologists, combined to write a policy statement supporting the use of pasteurized donor human milk in high risk preterm infants, with priority for those less than 1500 grams, when mother’s milk is not available. It states that the use of donor human milk in preterm infants is consistent with good health care. It recognizes that the use of donor milk is limited by its availability and affordability. It asserts boldly that the use of donor human milk should not be limited by an individual’s ability to pay. It urges health care providers to advocate for policies that assure reimbursement for its cost, while expanding the growth of milk banks by improving governmental and private financial support.



The policy states that donor milk for these high risk infants be obtained only from HMBANA and commercial milk banks that identify and screen donors, pasteurize milk and culture the post-pasteurization milk according to quality-control guidelines.  It discourages families from direct human milk sharing or purchasing from the internet due to the increased risks of infections and the potential exposure to contamination with medications, drugs or other substances. It recognizes, however, that current pasteurization methods destroy many bioactive components of donor milk and encourages the development of alternative sterilization methods that better preserve these factors. 

The statement states that the optimal feeding choice for preterm infants is mother’s own milk. Donor milk should be used when mother’s milk is unavailable or as a bridge or support while the mother’s milk is made available. It urges health professionals to encourage and assist mothers to pump or express milk and to provide their own milk whenever possible. But it also encourages providers to discuss with these families the high level of safety of milk obtained from milk banks and the tremendous benefits of human milk.

We can now envision a future where the overwhelming majority of high risk preterm infants will receive the low-tech, but very powerful, intervention of an exclusive diet of mother’s and/or donor milk. 

Donor Human Milk for the High-Risk Infant: Preparation, Safety and Usage Options in the U.S. This AAP policy will be published in the January issue of Pediatrics.

Larry Noble MD, FABM, IBCLC is a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai and Elmhurst Hospital in New York City, the Secretary of ABM and Policy Chair of the AAP Section on Breastfeeding. He declares a hugh conflict of interest as one of the Lead Authors on this Policy Statement. You can follow him on Twitter @GalactoDoc

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.


Written by galactodoc

December 22, 2016 at 8:13 am

2 Responses

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  1. In response to the AAP’s forthcoming Policy Statement on Donor Human Milk, the Australian Breast Milk Bank is actively developing new pasteurization methods to protect the bio-active components of donor milk destroyed through Holder and sterilization. . .
    Retention of immunology is one of the key goals of the Australian Breast Milk Bank. Sterilization is not an option for us. Other goals include affordability, the option of non-refrigerated storage/shipping as well as new approaches to ensure volume supply not based on provider payments.
    In the first quarter 2017, our Bank will test five different non-thermal process methods that we are very confident hold the key to pathogen control, immunology retention and cost efficient processing with a target end user pricing of under $50 per liter (33,8 fl.oz.).
    We are aiming to use advanced analytical techniques, such as x-scattering, in addition to standard assessments. Our research will be made public.
    Readers interested in our project can contact us to be notified of developments as we gear up for our production.
    Kevin Condon
    Australian Breast Milk Bank

    Kevin Condon

    December 26, 2016 at 9:37 pm

    • I would be very interested to learn of your developments in improving pasteurisation techniques to increase the retention of immunoglobulins in donor milk during processing. I established the Northwest Human Milk Bank Service UK 16 years ago and am currently working on a teaching package for personell working in HMB services. Thank you in anticipation.

      Lynda Coulter MBE

      January 29, 2017 at 9:50 am

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