Using Donor Breast Milk for Preemies

Breast Milk Storage Bottles for NICU baby

Jamie Grill / Getty Images

When your preemie is in the NICU, it is very likely that you’ll be asked to consider using donor breast milk, in one form or another. Whether it’s to provide milk because you are unable to produce enough milk for your baby, or it's to provide an important supplement which adds calories and nutrients to your own breast milk, the reality is that human milk products are becoming more and more commonplace.

When new parents are presented with this information, they may have mixed feelings about it. 

So let’s take a look at what’s involved.

Types of Donor Milk Products for Preemies in the NICU

There are two major uses of donated human breast milk in the NICU: ready-to-feed plain breast milk, and breast milk fortifier.

1. Donor Milk. When a baby’s birth mother is unable or unwilling to pump milk, Donor Milk can be used. In the NICU, this will be a pasteurized milk from an accredited milk bank, and it is used exactly as a mother's own milk might be used.

2. Human Milk Fortifier (HMF) is another important source of nutrition for preemies. This is added to breast milk — either a mother’s own milk or plain donor milk — in order to add valuable calories and nutrients to the baby’s diet.

Rather than being made from dairy (cow) milk, as has been the standard for years, it can now be made from donated human milk. 

This is an exciting new option because preemies tolerate diets of human milk better than they tolerate diets of dairy-based diets. While most HMF's are dairy-based, there is one company currently producing human-milk based HMF — Prolacta Bioscience, based in California.

Is Donor Milk and Fortifier Safe?

This is the main question preemie parents have, and it’s a wise one to ask. The short answer is yes, it is quite safe. But let’s look closer. How can we know it’s safe?

Almost all NICU's will require that any donor milk used to come from an accredited milk bank such as those that follow the strict guidelines established by The Human Milk Bank Association of North America

Donors are thoroughly screened, with phone interviews and screening questionnaires more rigorous than required for blood donation. Then, donated milk is pasteurized and tested for any bacterial growth, with any growth resulting in the milk being rejected. 

You can read the whole list of safety measures that Prolacta shares about how milk is safely processed at their website, but some highlights are:

  • Donors complete thorough medical histories
  • Donors have to have the written approval of her physician and her baby’s physician
  • Blood tests and DNA swabs are conducted to screen for HIV, Hepatitis B & C, syphilis. (The DNA swab is done so that every bottle of milk can be checked to verify that it actually comes from the mother and nobody else)
  • Each donor is screened again after four months if she wishes to continue donating.
  • Donated milk is tested for recreational and prescription drugs present in the milk
  • A full microbiological panel including Aerobic count, B. cereus, E. coli, Salmonella, Pseudomonas aeruginosa, coliforms, Staphylococcus aureus, yeast, and mold is completed on each pasteurized bottle.

Who donates milk? Women are screened to be sure they:

  • are in good health
  • don’t use drugs or tobacco
  • are willing to undergo blood testing to confirm their health
  • safely have excess milk to donate

When it’s donated, what happens with it? Check out the processing standards of the two major donor milk sources in the US:

Why Is It Important for Preemies?

An in-depth discussion about the benefits of human milk for preemies in the NICU is beyond the scope of this article, but some important factors to consider include:

1. The American Academy of Pediatrics recommends donor milk for preemies and low-birth-weight babies in the NICU when mother's own milk is not available.

2. Feeding babies human milk:

  • Decreases the incidence and severity of bacterial meningitis, bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, and sepsis in preterm infants.
  • May decrease rates of sudden infant death syndrome
  • May reduce the incidence of insulin-dependent (type 1) and non–insulin-dependent (type 2) diabetes mellitus, lymphoma, leukemia, Hodgkin’s disease, overweight and obesity, hypercholesterolemia, and asthma.
  • May result in greater IQ than diets of bovine based milk
  • May reduce the length of NICU stay

Donating Milk

If you are considering donating your excess breast milk, you may be helping save the life of a preemie. It's an incredible gift of life.

Visit the non-profit Human Milk Bank Association of North Americ Donation page or the for-profit Prolacta Biosciences Find-a-Milk-Bank page.

For other countries’ milk banking organizations, please see International Milk Banking or United Kingdom Association for Milk Banking.

4 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Underwood MA. Human milk for the premature infant. Pediatr Clin North Am. 2013;60(1):189-207. doi:10.1016/j.pcl.2012.09.008

  2. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-41. doi:10.1542/peds.2011-3552

  3. Isaacs EB, Fischl BR, Quinn BT, Chong WK, Gadian DG, Lucas A. Impact of breast milk on intelligence quotient, brain size, and white matter development. Pediatr Res. 2010;67(4):357-62. doi:10.1203/PDR.0b013e3181d026da

  4. Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010;37(1):217-45. doi:10.1016/j.clp.2010.01.013

Additional Reading

  • Cristofalo, Elizabeth A., et al. "Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants." The Journal of pediatrics 163.6 (2013): 1592-1595.

  • Eidelman, Arthur I., et al. "Breastfeeding and the use of human milk." Pediatrics 129.3 (2012): e827-e841.

  • Perrine, Cria G., and Kelley S. Scanlon. "Prevalence of use of human milk in US advanced care neonatal units." Pediatrics 131.6 (2013): 1066-1071.

  • Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156(4):562–567, e1pmid:20036378

  • Vohr BR, Poindexter BB, Dusick AM, et al., National Institute of Child Health and Human Development National Research Network. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007;120(4). Available at:

By Trish Ringley, RN
Trish Ringley, RN, has been a NICU nurse since 1997 and owns Every Tiny Thing, an online store serving preemies and NICU families.