Pasteurized Donor Human Milk: Human Milk for Human Babies

Pasteurized Donor Human Milk (PDHM) is human milk that has been donated to a milk bank and pasteurized in a gentle heat treatment process which kills bacteria and viruses while maintaining the milk’s nutritional value.  PDHM goes through a rigorous testing process to ensure high quality and safety.   Most medical centers which care for premature infants will use PDHM to meet the needs of some of the most fragile babies in the Neonatal Intensive Care Unit (NICU), as it is well-established that human milk reduces the risk of necrotizing enterocolitis (NEC).   Recently, PDHM has become more available, and its use has extended to include late preterm, early term and even full-term infants who need nutritional support in addition to breastfeeding.  

So what are your thoughts about PDHM?  Do you use it at your hospital or in your practice?  Do you support the use of PDHM?  Do you believe it is superior to manufactured infant formula (IF)?   It’s an interesting phenomenon that healthcare providers have reservations about using PDHM over IF.   Some of the common causes for these reservations may be myths that need clarification-

 MYTHS:

• PDHM is unsafe because of the risk of infection from a donor mother.
  • Donors are thoroughly screened for any infection and milk is also tested for bacteria and viruses prior to distribution.
  • Risk of harm from PDHM is extremely rare and significantly lower than the risks of IF
• Pasteurization inactivates immunoglobulins
  • Holder pasteurization does have some effect on the immunoglobulins but it does not destroy them all. About 60% of IgA is still available.  
  • Compare to zero IgA in IF.
• There are not enough calories in PDHM
  • Donor mothers are instructed to actively express their milk (as opposed to passive or “drip” collection) so that the higher calorie milk is collected.
  • Milk from several donors is pooled and calorie content can be measured prior to distribution. Some milk banks offer  high calorie PDHM as well.
• PDHM is too expensive
  • PDHM costs approximately $14.00 for 100 mL. In the setting of prematurity, the cost of treating one infant with NEC far outweighs the cost of PDHM.
  • In the full-term setting, PDHM is a temporary bridge for situations in which newborns don’t have access to mom’s milk. These are short-term situations and since newborn volume intake is low, 2-3 bottles of PDHM are typically sufficient to bridge this gap.  That’s $42  - not a bank breaker.

As the lead on introduction of PDHM to my former hospital, my least favorite response from staff was, “I just don’t like it – it’s a bodily fluid.”    Yes, that is true – not a myth - but infant formula is also a bodily fluid – from a cow! Cows carry diseases, bacteria and viruses too, but few seem to worry about  that.  The fact that as a culture, we find processed cow’s milk superior to human milk for our  babies is striking, and pardon the pun, but “food for thought.”

The use of PDHM supports the current recommendations of exclusive breastfeeding and breast milk feeding for the first six months of life.  It also supports those families who have a goal of exclusive breastfeeding.   It speaks volumes to patients when hospitals values breastfeeding enough to provide PDHM as a choice for supplementation.   If you’re interested in learning more about PDHM check out the Human Milk Banking Association of North America (HMBNA)  website:

https://ww.hmbana.org

If your hospital is using PDHM, fantastic!  If your hospital is not providing PDHM, consider contacting your local milk bank to find out how you can advocate for this important, evidence-based infant nutritional support at your organization, because human milk is best for human babies.