BACKGROUND: The Human Milk Banking Association of North America (HMBANA) is a nonprofit association that standardizes and facilitates the establishment and operation of donor human milk banks in North America. No study has characterized the demographics, characteristics, and geographic distribution of its donors. MATERIALS AND METHODS: Donors were eligible for inclusion if they were donors at MMBNE, provided a gestational age for their infant, and donated between 1/1/2011-9/1/2019. Data collected from donor surveys and milk collection procedures were analyzed using descriptive statistics, chi-square tests, t tests of independence and Mann-Whitney U tests. RESULTS: Data were analyzed from 3767 donors. On average, donors were 32.5 years old (range 17-52) and donated more than once (mean 2.8; median 2; IQR 1-3; range 1-41). The majority of donors gave birth to term infants, lived in New England, and were not bereaved. Massachusetts had the largest proportion of donors (40.9%), however donors were located in 39 states and four countries. The median total volume donated per donor was 21904mL (741Oz). The average volume of donation per donor increased over time. Mothers who had preterm births were more likely to be bereaved (66% vs. 13%; p<0.01) and the volume of donation (mL) was associated with term versus preterm birth status respectively (p<0.01). CONCLUSION: Donors to MMBNE were generally older, repeat donors with term infants, and broadly geographically distributed. Further research is warranted to understand additional characteristics associated with milk donation and any characteristics of mothers who are and are not able to donate milk in accordance with milk bank protocols.

For most of human history, breastfeeding has been the optimal source of nutrition for infants. Human milk contains a variety of important nutritional sources including vitamins, fats, proteins, and immunological components. With the rise of artificial infant formulas, however, breastfeeding as a whole has decreased around the world. Preterm infants are especially susceptible to diseases such as necrotizing enterocolitis in the first few weeks of life. Therefore, they have the most to gain from the extra immunological and nutritional support that is present in human milk. Within the last few decades, donor human milk has been viewed as the next best option if mothers own milk is not available. Donor human milk contains many of the same beneficial milk properties as regular human milk including immunoglobulins and human milk oligosaccharides. Studies have shown decreases in preterm cases of NEC and fewer deaths in infants who received DHM. One argument against the use of DHM is that pasteurization can reduce the beneficial enzymes and immunoglobulins present in samples. However, the increased use of human milk fortifiers has been able to significantly decrease the nutrient gap between regular human milk and donor milk. Overall, DHM along with proper fortification serves as the best and most cost effective way to feed preterm infants if mother’s milk is unavailable.

Very low birth weight and extremely low birth weight neonates have tremendous risk of mortality. This is a grave concern; however, survival alone is not the goal of neonatal intensive care. Survival, along with a reduction or elimination of life long morbidity is the aim of neonatal intensive care. Human milk is known as the best nutrition for babies and a growing body of evidence supports that human milk is critical in helping these fragile neonates mitigate the overwhelming risks they face. Therefore, the purpose of this study was to examine the relationship between neonatal severity of illness and human milk, specifically mothers own milk (MOM), donor human milk (DHM), and total human milk (THM) intake in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants over the first six weeks of life. Although there is a growing body of evidence that supports the use of human milk in this fragile neonatal population, information is lacking about the relationship between human milk and neonatal illness severity. The current study was a secondary data analysis from a National Institutes of Health (NIH) funded R21 study in a level three NICU in Florida. Multilevel modeling was used for data analysis to examine relationships between maternal dyad characteristics and severity of illness, operationalized by the Score for Neonatal Acute Physiology-II (SNAP-II), at 12 hours of life and at the end of each week of life for six weeks. Growth models (linear, quadratic, piecewise) were examined to determine the best model fit for the data, then predictor variables were added and model fit was tested. Birth weight was added to final models as a control as it is seen as a proxy for severity of illness in the literature. Model six demonstrated a significant inverse relationship between MOM(mL) (γMOM(mL)) = -.000079, p < .05) and SNAP-II scores (Deviance = 287.862, Δχ2(df) = 31.38(1), p < .001, AIC = 303.862, BIC = 336.930). Model 11 demonstrated a significant inverse relationship between THM(mL) (γTHM(mL) = -.000127, p < .001) and SNAP-II scores (Deviance = 279.280, Δχ2(df) = 30.859(1), p < .001, AIC = 295.280, BIC = 328.347). No relationships were noted between severity of illness and DHM(mL), MOM(%), DHM(%), or THM(%). Therefore the relationships noted between MOM(mL) and THM(mL) and neonatal severity of illness should be interpreted with caution.