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Donor Breast Milk Use for

Term Infants
Laura Zamora, BSN, RN, IBCLC Duke Regional Lactation Services
Donor Breast Milk Use at Duke Regional
• Currently at Duke Regional
Hospital we use donor breast
milk not only in our special care
nursery with preemie and higher
level of care babies, but also
with our term infants under
certain circumstances
• Acts as a “bridge” to exclusive
breastfeeding, which otherwise
might not be possible with
certain risk factors
Who uses donor breast milk?
• Mother whose goal is to exclusively breastfeed but has any of the
following risk factors:
• Hypoglycemic Infants with risk factors such as small for gestational age, large
for gestational age, infant of diabetic mother, etc.
• Hyperbilirubinemia
• Weight loss > 10% or with provider order
• Infants with intolerance to formula and mother’s mature milk supply
not yet established
• Mother with medical conditions that delay onset of lactogenesis
What is the process?
• Provider order
• Benefits explained to parents by
care RN/lactation
• Consent form review and
• Thaw bottle of donor breast milk
using milk warmer
Process (continued)
• Once thawed, bottle is good for
24 hours in refrigerator, after
this must be discarded if not
• Placed desired amount of milk
into clean snappy/bottle/syringe
• Dual sign off-2 RNs must verify
patient, expiration date of breast
milk, thaw date, and quantity
• Warm milk and bring to patient
Tools for Nursing Staff
for Patients
ns e
C rm
F o
Log for Use of Donor Breast Milk
Wake Med Milk Bank
• Milk is obtained from Wake Med
Milk Bank in Raleigh, NC
• Order is placed once per month
• For our patient population we
order 160 ounces per month-
came to this number by
monitoring usage
• If ordered before 1100 we get
milk the same day, if after we get
the milk the next day
• Currently we do not have tracking system for waste
• To reduce waste, we do not pre thaw, we only thaw after consent is
signed when ready to feed
• Already open bottles are sent home with discharging patients which
eliminates waste-these bottles are placed on log and parents taught
proper handling of pasteurized human milk in the home
Donor Breast Milk vs. Formula Cost
• Donor breast milk is $4.50/ounce
• Formula costs 9 cents/bottle
• Benefits for babies are worth the cost of average $724/month that we
as a hospital spend for DBM
Benefits of Breast milk
Decreased risk of
• Inflammatory Bowel Disease
• Respiratory infections
• Asthma
• Obesity
• Type II Diabetes
• Ear infections
• Has pre biotic and pro biotic activity, which improves the gut flora
Potential risks of infant formula
• Formula exposure during the newborn period, when the gut is being
colonized can interrupt the protective colonization of the gut
• May lead to alterations in newborn gut flora which can result in
inflammation and/or infection as well as sensitization to foreign
proteins (allergy)
• Due to longer metabolism of infant formula may decrease the feeding
frequency of the infant
• Reduced health benefits of exclusive breastfeeding
What does the research say?
• Improving the proportion of infants who have access to B-HM remains a global public health priority (WHO,

• There is still reluctance among healthcare providers in some countries (including the United Kingdom and
Ireland) to use B-HM despite having operation guidelines because of perceived limited evidence of benefit
and attitudes related to its acceptability (Modi, 2006).

• Ward et al. (2012) used a quality improvement framework to increase the proportion of small for gestational
age (SGA) infants who receive pasteurized B-HM in the first 14 days of life. More recently, Brandstetter et al.
(2018) put forth a decision tree to assist healthcare providers in balancing limited supply of B-HM,
prioritization, and supporting continued breastfeeding and provision of parents’ own milk.

• B-HM implementation may be strongly supported by healthcare providers, but other barriers to promoting
them may exist within some institutions. For example, a study in India found that staffing shortages were a
barrier to documenting parents’ informed consent for B-HM, and there were other challenges, including
inadequate supply of human milk donations, and a shortage of trained staff to collect milk (Mondkar et al.,
Why We Choose DBM at DRH
• Patient satisfaction is key
• Many mothers are thrilled when LC offers option of Donor Breast Milk
for supplementation
• To mothers, gives piece of mind that their baby is still receiving the
benefits of breast milk, which eases patients’ stress in times where
supplementation is needed
• Any questions can be directed to
Laura Zamora
• World Health Organization (WHO). (2014a). Comprehensive implementation plan on
maternal, infant and young child nutrition. Geneva, Switzerland: Author.
• World Health Organization (WHO). (2015c). Donor human milk for low-birth-weight
infants. Geneva, Switzerland: Author.
• World Health Organization (WHO). (2008). Infant and young child nutrition: Biennial
progress report. Geneva, Switzerland: Author.
• World Health Organization (WHO). (2009). Acceptable medical reasons for use of breast-
milk substitutes. Geneva, Switzerland: Author.
• World Health Organization (WHO). (2003). Global strategy
for infant and young child feeding. Geneva, Switzerland: Author.
• Aunchalee E. L. Palmquist, PhD, MA, IBCLC, Maryanne T. Perrin, PhD, MBA, Diana Cassar-
Uhl, MPH, IBCLC, Karleen D. Gribble, PhD, Angela B. Bond, PhD, MS5, and Tanya Cassidy,
PhD, AM, MA: Current Trends in Research on Human Milk Exchange for Infant Feeding.
Journal of Human Lactation (JHL). Vol. 35(3) 453–477(2019