Human Donor Milk Bank Variations of Macronutrients and Implications for Fragile Infants

Abstract Objectives Human milk is known to be the best source of nutrients for human infants. When a mother's own milk is not available donor human milk is an alternative. Donor human milk (DHM) is categorized by caloric quantity, typically 20 calories per ounce and 24 calories per ounce. The DHM is prepared for distribution in Lots. The range of macronutrient content within and between Lots is unknown. This study analyzed multiple Lots from one milk bank for macronutrient content to evaluate the range of macronutrient and energy content within and between Lot samples. Methods Frozen DHM at its expiration date for infant consumption was collected from a local hospital neonatal intensive care unit. Samples were collected at random from each Lot of either 20 kcal/ounce and 24 kcal/ounce. Each bottle was thawed, inverted 5 times, and 3 5-ml aliquots were removed from each bottle. Each aliquot was labeled and then the triplicate samples were analyzed using a MIRIS human milk analyzer with a Standard milk sample used as calibration after every 10th sample analyzed. Comparisons between bank-labeled macronutrient and energy content for each sample was evaluated for differences with two-sided P values < 0.05 considered statistically significant. Results Highly statistically significant differences were found within and between Lots of the DHM. Protein content differed in 58% of the samples from the protein content listed on the label protein content by more than .03 g/dl. The energy content differed from the label in 72% of the samples with an average difference of more than 3 units. Conclusions The differences found between and within the Lots may pose a challenge for consistency of calorie intake in infants receiving only DHM if the energy content is assumed based on the labeling DHM. Due to the differences found in this analysis, the nutrient intake may not meet the needs of an ill or fragile infants being fed from certain Lots of DHM. Samples of DHM being fed to high-risk infants should be regularly evaluated for macronutrient content to ensure adequacy of the feeds. Funding Sources The Foundation for Maternal, Infant, and Lactation Knowledge provided student scholarship support for this study.