Is preterm donor milk better than preterm formula for very-low-birth-weight infants?

  • Lingyu Fang Neonatal Intensive Care Unit, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
  • Meili Zhang Neonatal Intensive Care Unit, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
  • Lianqiang Wu Neonatal Intensive Care Unit, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
  • Ruiquan Wang Neonatal Intensive Care Unit, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
  • Bangbang Lin Administrative Office, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
  • Jianfeng Yao Reproductive Medicine Center, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
  • Dongmei Chen Neonatal Intensive Care Unit, Quanzhou Women and Children’s Hospital, Quanzhou, Fujian, China
Keywords: milk bank, very-low-birth-weight infant, development and growth, necrotizing enterocolitis, sepsis


Background: Preterm human milk has advantages over preterm formula (PF), but it may compromise some functions after pasteurization.

Objective: To explore the effects of preterm donor milk (DM) on growth, feeding tolerance, and severe morbidity in very-low-birth-weight infants.

Method: This was a single-center, prospective cohort study that included 304 preterm infants weighing <1,500 g or of gestational age <32 weeks. If the mother’s own milk was insufficient, the parents decided to use PF (n = 155) or DM (n = 149). The two groups were uniformly managed according to the standard NICU protocol. Growth parameters, feeding tolerance, and severe morbidity such as necrotizing enterocolitis, were compared between the two groups.

Results: The daily weight gain and weekly head growth in the DM group were not different from those in the PF group (P > 0.05). Feeding intolerance in the DM group was significantly lower than that in PF group (P < 0.05), and parenteral nutrition time and hospitalization time were also shorter than that in the PF group (P < 0.05). Moreover, the incidence of necrotizing enterocolitis and sepsis was also significantly lower in the DM group (P < 0.05).

Conclusion: The study indicated that preterm DM does not affect the growth of very-low-birth-weight infants. Further, it significantly reduces feeding intolerance, helps achieve full enteral feeding early, and has protective effects against necrotizing enterocolitis and sepsis. Thus, compared with formula, preterm DM can lower the rate of infection in preterm infants and is worthy of promotion.


Download data is not yet available.


  1. Corpeleijn WE, Kouwenhoven SM, Paap MC, van Vliet I, Scheerder I, Muizer Y, et al. Intake of own mother’s milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology 2012; 102(4): 276–81. doi: 10.1159/000341335

  2. Lewis ED, Richard C, Larsen BM, Field CJ. The importance of human milk for immunity in preterm infants. Clin Perinatol 2017; 44(1): 23–47. doi: 10.1016/j.clp.2016.11.008

  3. Miller J, Tonkin E, Damarell RA, McPhee AJ, Suganuma M, Suganuma H, et al. A systematic review and meta-analysis of human milk feeding and morbidity in very low birth weight infants. Nutrients 2018; 10(6): 707. doi: 10.3390/nu10060707

  4. Collado MC, Cernada M, Neu J, Perez-Martinez G, Gormaz M, Vento M. Factors influencing gastrointestinal tract and microbiota immune interaction in preterm infants. Pediatr Res 2015; 77(6): 726–31. doi: 10.1038/pr.2015.54

  5. Committee on Nutrition, Section on Breastfeeding, Committee on Fetus and Newborn. Donor human milk for the high-risk infant: preparation, safety, and usage options in the United States. Pediatrics 2017; 139(1): e20163440. doi: 10.1542/peds.2016-3440

  6. ESPGHAN Committee in Nutrition, Arslanoglu S, Corpeleijn W, Moro G, Braegger C, Campoy C, et al. Donor human milk for preterm infants: current evidence and research directions. J Pediatr Gastroenterol Nutr 2013; 57(4): 535–42. doi: 10.1097/MPG.0b013e3182a3af0a

  7. Group of Human Milk Bank CoCHCMDA. [Characteristics of the Chinese human milk banks’ operation]. Zhonghua Er Ke Za Zhi 2017; 55(8): 597–601. doi: 10.3760/cma.j.issn.0578-1310.2017.08.010

  8. Madore LS, Bora S, Erdei C, Jumani T, Dengos AR, Sen S. Effects of donor breastmilk feeding on growth and early neurodevelopmental outcomes in preterm infants: an observational study. Clin Therapeut 2017; 39(6): 1210–20. doi: 10.1016/j.clinthera.2017.05.341

  9. Radmacher PG, Lewis SL, Adamkin DH. Individualizing fortification of human milk using real time human milk analysis. J Neonatal Perinatal Med 2013; 6(4): 319–23. doi: 10.3233/NPM-1373113

  10. Castro M, Asbury M, Shama S, Stone D, Yoon EW, O’Connor DL, et al. Energy and fat intake for preterm infants fed donor milk is significantly impacted by enteral feeding method. JPEN J Parenteral Enteral Nnutr 2019; 43(1): 162–5. doi: 10.1002/jpen.1430

  11. Adhisivam B, Kohat D, Tanigasalam V, Bhat V, Plakkal N, Palanivel C. Does fortification of pasteurized donor human milk increase the incidence of necrotizing enterocolitis among preterm neonates? A randomized controlled trial. J Mater Fetal Neonatal Med 2019; 32(19): 3232–7. doi: 10.1080/14767058.2018.1461828

  12. Huston R, Lee M, Rider E, Stawarz M, Hedstrom D, Pence M, et al. Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier. J Neonatal Perinatal Med 2020; 13(2): 215–21. doi: 10.3233/NPM-190300

  13. de Halleux V, Pieltain C, Senterre T, Rigo J. Use of donor milk in the neonatal intensive care unit. Semin Fetal Neonatal Med 2017; 22(1): 23–9. doi: 10.1016/j.siny.2016.08.003

  14. Brown JV, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2016; (5): CD000343. doi: 10.1002/14651858.CD000343.pub3

  15. Kantorowska A, Wei JC, Cohen RS, Lawrence RA, Gould JB, Lee HC. Impact of donor milk availability on breast milk use and necrotizing enterocolitis rates. Pediatrics 2016; 137(3): e20153123. doi: 10.1542/peds.2015-3123

  16. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2018; 6: CD002971. doi: 10.1002/14651858.CD002971.pub4

  17. Cristofalo EA, Schanler RJ, Blanco CL, Sullivan S, Trawoeger R, Kiechl-Kohlendorfer U, et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr 2013; 163(6): 1592–5.e1. doi: 10.1016/j.jpeds.2013.07.011

  18. Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens V, Steggerda SJ, et al. Bloodstream infection incidence of different central venous catheters in neonates: a descriptive cohort study. Front Pediatr 2017; 5: 142. doi: 10.3389/fped.2017.00142

  19. Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics 2013; 132(6): e1609–15. doi: 10.1542/peds.2013-1645

  20. Corpeleijn WE, de Waard M, Christmann V, van Goudoever JB, Jansen-van der Weide MC, Kooi EM, et al. Effect of donor milk on severe infections and mortality in very low-birth-weight infants: the early nutrition study randomized clinical trial. JAMA Pediatr 2016; 170(7): 654–61. doi: 10.1001/jamapediatrics.2016.0183

  21. Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol 2009; 29(1): 57–62. doi: 10.1038/jp.2008.117

  22. Villamor-Martinez E, Pierro M, Cavallaro G, Mosca F, Kramer BW, Villamor E. Donor human milk protects against bronchopulmonary dysplasia: a systematic review and meta-analysis. Nutrients 2018; 10(2): 238. doi: 10.3390/nu10020238

  23. Kreissl A, Sauerzapf E, Repa A, Binder C, Thanhaeuser M, Jilma B, et al. Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants. Acta Paediatr 2017; 106(9): 1460–7. doi: 10.1111/apa.13914

  24. Agostoni C, Buonocore G, Carnielli VP, Curtis MD, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010 Jan; 50(1): 85–91. doi: 10.1097/MPG.0b013e3181adaee0

  25. Dutta S, Singh B, Chessell L, Wilson J, Janes M, McDonald M, et al. Guidelines for feeding very low birth weight infants. Nutrients 2015 Jan 8; 7(1): 423–42. doi: 10.3390/nu7010423

How to Cite
Fang L., Zhang M., Wu L., Wang R., Lin B., Yao J., & Chen D. (2021). Is preterm donor milk better than preterm formula for very-low-birth-weight infants?. Food & Nutrition Research, 65.
Original Articles