Benefits of donor milk in the feeding of preterm infants Enrico Bertino, Francesca Giuliani, Marta Baricco, Paola Di Nicola, Chiara Peila, Cristina Vassia, Federica Chiale, Alice Pirra, Francesco Cresi ⁎, Claudio Martano, Alessandra Coscia SCDU Neonatology, Università degli Studi di Torino, Italy abstract article info Available online xxxx Keywords: Donor human milk Breastfeeding Preterm infant Mother's own milk is widely recognized as the optimal feeding for term infants, but also provides health ben- efits that are of vital importance for sick and preterm infants in neonatal intensive care units (NICUs), even though the growth and neurodevelopmental needs of very premature infants are best met by appropriate fortification of human milk (HM). When mother's milk is unavailable or in short supply, donor milk (DM) represents the second best alternative and, although some nutritional elements are inactivated by the pasteurization process, it still has documented advantages compared to formula. Occasionally, the concern that the use of DM might decrease breastfeeding is being raised, but reports exist in literature showing that the use of donor HM in the NICU increases breastfeeding rates at discharge for VLBW infants. The dem- onstrated benefits of HM highlight the importance of educating health care professionals in breastfeeding support. © 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction It is a universally recognized fact that breastfeeding is the normative standard for feeding and nutrition of infants born at term until six months of age, followed by complementary feeding and continued, if possible, well beyond one year of life [1]. Emerging evidence over recent decades has also confirmed that there are substantial benefits to the use of human milk (HM) for sick and preterm infants in neonatal intensive care units (NICUs), even though the growth and neuro- developmental needs of the evolutionarily new population [see above] of very premature infants are best met by appropriate fortifica- tion of HM [2]. Feeding HM to preterm infants decreases rates of infec- tion, necrotizing enterocolitis (NEC) and mortality, while improving neurocognitive and cardiovascular outcomes in the long term. Mother's own milk is the first choice for all neonates including preterm infants, and, when it is not available or not sufficient, despite significant lacta- tion support, donor HM is a valid alternative [1,3,4]. 1.1. Biological aspects HM can be considered a species-specific biological "dynamic" sys- tem. Particular attention should be given to specific bioactive and immunomodulatory factors, such as gastrointestinal hormones, im- munoglobulins, lactoferrin, lysozyme, oligosaccharides, nucleotides, growth factors, enzymes, antioxidants and cellular components that not only ensure adequate host defense against infections, but also actively modulate the immune response and modify the intestinal bacterial flora [5–7]. Among these factors, oligosaccharides have a particularly impor- tant role. Originally described as a prebiotic “bifidus factor” that serves as a metabolic substrate for desired bacteria and shapes an intestinal microbiota composition with health benefits for the breast-fed neo- nate, today oligosaccharides are known to be more than just “food for bugs”: literature shows that oligosaccharides also directly act to prevent pathogen adhesion to infant mucosal surfaces, lowering the risk of infections, and modulate epithelial and immune cell responses [8]. Qualitatively and quantitatively, their presence in milk is strictly related to the expression of the mother's Se and/or Le genes: on this basis, four different milk groups have been described. Substantial dif- ferences in oligosaccharide content were found within the groups and these were strictly related to the presence or absence of specific fucosyl-oligosaccharides. A recent study performed by our group re- ported new data on oligosaccharide concentrations in the four milk groups. These differences might exert an influence on several biologi- cal functions that are important for preterm infants and currently are attributed to milk oligosaccharides. But what was more striking was the higher concentrations of HM Oligosaccharides (HMOs) in preterm compared with term milk. This highlights the significant role of breastfeeding for preterm infants, who, because of the immaturity of their organs and systems, are at greater risk of contracting infectious illnesses. The concentrations of the different HMOs in preterm and term milk might represent a programmed adaptation of milk compo- sition to the specific needs of the infants. Lower lactose concentrations in preterm milk compared with term milk were also described. Low lactose concentrations in milk might have positive effects in preterm nutrition, because lactose contributes to lower milk osmolality. Low Early Human Development xxx (2013) xxx–xxx ⁎ Corresponding author at: SCDU Neonatologia, Via Ventimiglia, 3, 10131 Torino, Italy. Tel.: +39 0113135775. E-mail address: enrico.bertino@unito.it (E. Bertino). EHD-03817; No of Pages 4 0378-3782/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.earlhumdev.2013.07.008 Contents lists available at SciVerse ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev Please cite this article as: Bertino E, et al, Benefits of donor milk in the feeding of preterm infants, Early Hum Dev (2013), http://dx.doi.org/ 10.1016/j.earlhumdev.2013.07.008