Human Milk and Premature Infant: Focus on Use of Pasteurized Donor Human Milk in NICU

  • Mark A. UnderwoodEmail author
  • Jennifer A. Scoble
Reference work entry


Human milk is the ideal source of nutrition for the healthy term infant and has significant advantages for the premature and/or critically ill infant. The advantages of unpasteurized mother’s own milk over pasteurized human donor milk include higher content of protein, fat, some minerals and vitamins, and several bioactive molecules. These advantages translate to better growth and fewer episodes of necrotizing enterocolitis among premature infants. Pasteurized donor human milk is the preferred nutrition for premature infants when the supply of mother’s own milk is limited. The following are likely to improve outcomes of premature and critically ill infants: increased use of mother’s own milk, increased availability of pasteurized donor human milk, and improved techniques for eliminating potential milk pathogens without decreasing the nutritional and bio-protective capacity of human milk.


Premature Infant Human Milk Formula Group Milk Bank Preterm Formula 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations




C-reactive protein


Deoxyribonucleic acid


High-density lipoprotein


Human immunodeficiency virus


Human T-cell lymphotropic virus


High-temperature short-time






Low-density lipoprotein


Necrotizing enterocolitis


Pasteurized donor human milk


Very low birth weight


  1. Albesharat R, Ehrmann MA, Korakli M, Yazaji S, Vogel RF. Phenotypic and genotypic analyses of lactic acid bacteria in local fermented food, breast milk and faeces of mothers and their babies. Syst Appl Microbiol. 2011;34(2):148–55.CrossRefPubMedGoogle Scholar
  2. American Academy of Pediatrics Committee on Pediatric AIDS. Infant feeding and transmission of human immunodeficiency virus in the United States. Pediatrics. 2013;131(2):391–6.CrossRefGoogle Scholar
  3. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41.CrossRefGoogle Scholar
  4. Andersson Y, Savman K, Blackberg L, Hernell O. Pasteurization of mother’s own milk reduces fat absorption and growth in preterm infants. Acta Paediatr. 2007;96(10):1445–9.CrossRefPubMedGoogle Scholar
  5. Baro C, Giribaldi M, Arslanoglu S, Giuffrida MG, Dellavalle G, Conti A, Tonetto P, Biasini A, Coscia A, Fabris C, Moro GE, Cavallarin L, Bertino E. Effect of two pasteurization methods on the protein content of human milk. Front Biosci (Elite Ed). 2011;3:818–29.Google Scholar
  6. Bertino E, Coppa GV, Giuliani F, Coscia A, Gabrielli O, Sabatino G, Sgarrella M, Testa T, Zampini L, Fabris C. Effects of holder pasteurization on human milk oligosaccharides. Int J Immunopathol Pharmacol. 2008;21(2):381–5.PubMedGoogle Scholar
  7. Braga LP, Palhares DB. Effect of evaporation and pasteurization in the biochemical and immunological composition of human milk. J Pediatr (Rio J). 2007;83(1):59–63.Google Scholar
  8. Bulterys M, Ellington S, Kourtis AP. HIV-1 and breastfeeding: biology of transmission and advances in prevention. Clin Perinatol. 2010;37(4):807–24. ix–x.CrossRefPubMedGoogle Scholar
  9. Burgard M, Jasseron C, Matheron S, Damond F, Hamrene K, Blanche S, Faye A, Rouzioux C, Warszawski J, Mandelbro L, A. F. P. C. EPF-CO. Mother-to-child transmission of HIV-2 infection from 1986 to 2007 in the ANRS French Perinatal Cohort EPF-CO1. Clin Infect Dis. 2010;51(7):833–43.CrossRefPubMedGoogle Scholar
  10. Cabrera-Rubio R, Collado MC, Laitinen K, Salminen S, Isolauri E, Mira A. The human milk microbiome changes over lactation and is shaped by maternal weight and mode of delivery. Am J Clin Nutr. 2012;96(3):544–51.CrossRefPubMedGoogle Scholar
  11. Centers for Disease Control and Prevention. CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC); 2012.
  12. Chantry CJ, Wiedeman J, Buehring G, Peerson JM, Hayfron K, K’Aluoch O, Lonnerdal B, Israel-Ballard K, Coutsoudis A, Abrams B. Effect of flash-heat treatment on antimicrobial activity of breastmilk. Breastfeed Med. 2011;6(3):111–6.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Christen L, Lai CT, Hartmann PE. Ultrasonication and the quality of human milk: variation of power and time of exposure. J Dairy Res. 2012;79(3):361–6.CrossRefPubMedGoogle Scholar
  14. Colaizy TT, Carlson S, Saftlas AF, Morriss Jr FH. Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study. BMC Pediatr. 2012;12:124.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Cossey V, Jeurissen A, Bossuyt X, Schuermans A. Effect of pasteurisation on the mannose-binding lectin activity and the concentration of soluble CD14 in human milk. J Hosp Infect. 2009;73(1):96–7.CrossRefPubMedGoogle Scholar
  16. Cossey V, Vanhole C, Eerdekens A, Rayyan M, Fieuws S, Schuermans A. Pasteurization of mother’s own milk for preterm infants does not reduce the incidence of late-onset sepsis. Neonatology. 2013;103(3):170–6.CrossRefPubMedGoogle Scholar
  17. Czank C, Prime DK, Hartmann B, Simmer K, Hartmann PE. Retention of the immunological proteins of pasteurized human milk in relation to pasteurizer design and practice. Pediatr Res. 2009;66(4):374–9.CrossRefPubMedGoogle Scholar
  18. Czank C, Simmer K, Hartmann PE. Simultaneous pasteurization and homogenization of human milk by combining heat and ultrasound: effect on milk quality. J Dairy Res. 2010;77(2):183–9.CrossRefPubMedGoogle Scholar
  19. da Costa RS, do Carmo MG, Saunders C, de Jesus EF, Lopes RT, Simabuco SM. Characterization of iron, copper and zinc levels in the colostrum of mothers of term and pre-term infants before and after pasteurization. Int J Food Sci Nutr. 2003;54(2):111–7.CrossRefPubMedGoogle Scholar
  20. de Oliveira PR, Yamamoto AY, de Souza CB, de Araujo NM, de Andrade Gomes S, Heck AR, de Castro Figueiredo JF, Mussi-Pinhata MM. Hepatitis B viral markers in banked human milk before and after holder pasteurization. J Clin Virol. 2009;45(4):281–4.CrossRefPubMedGoogle Scholar
  21. de Segura AG, Escuder D, Montilla A, Bustos G, Pallas C, Fernandez L, Corzo N, Rodriguez JM. Heating-induced bacteriological and biochemical modifications in human donor milk after holder pasteurisation. J Pediatr Gastroenterol Nutr. 2012;54(2):197–203.CrossRefPubMedGoogle Scholar
  22. Elisia I, Kitts DD. Quantification of hexanal as an index of lipid oxidation in human milk and association with antioxidant components. J Clin Biochem Nutr. 2011;49(3):147–52.CrossRefPubMedPubMedCentralGoogle Scholar
  23. European Paediatric Hepatitis C. V. N. Effects of mode of delivery and infant feeding on the risk of mother-to-child transmission of hepatitis C virus. European Paediatric Hepatitis C Virus Network. BJOG. 2001;108(4):371–7.CrossRefGoogle Scholar
  24. Ewaschuk JB, Unger S, Harvey S, O’Connor DL, Field CJ. Effect of pasteurization on immune components of milk: implications for feeding preterm infants. Appl Physiol Nutr Metab. 2011a;36(2):175–82.CrossRefPubMedGoogle Scholar
  25. Ewaschuk JB, Unger S, O’Connor DL, Stone D, Harvey S, Clandinin MT, Field CJ. Effect of pasteurization on selected immune components of donated human breast milk. J Perinatol. 2011b;31(9):593–8.CrossRefPubMedGoogle Scholar
  26. Ford JE, Law BA, Marshall VM, Reiter B. Influence of the heat treatment of human milk on some of its protective constituents. J Pediatr. 1977;90(1):29–35.CrossRefPubMedGoogle Scholar
  27. Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med. 2003;157(1):66–71.CrossRefPubMedGoogle Scholar
  28. Ganapathy V, Hay JW, Kim JH. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeed Med. 2012;7(1):29–37.CrossRefPubMedGoogle Scholar
  29. Goelz R, Hihn E, Hamprecht K, Dietz K, Jahn G, Poets C, Elmlinger M. Effects of different CMV-heat-inactivation-methods on growth factors in human breast milk. Pediatr Res. 2009;65(4):458–61.CrossRefPubMedGoogle Scholar
  30. Goes HC, Torres AG, Donangelo CM, Trugo NM. Nutrient composition of banked human milk in Brazil and influence of processing on zinc distribution in milk fractions. Nutrition. 2002;18(7–8):590–4.CrossRefPubMedGoogle Scholar
  31. Gross SJ. Growth and biochemical response of preterm infants fed human milk or modified infant formula. N Engl J Med. 1983;308(5):237–41.CrossRefPubMedGoogle Scholar
  32. Henderson TR, Fay TN, Hamosh M. Effect of pasteurization on long chain polyunsaturated fatty acid levels and enzyme activities of human milk. J Pediatr. 1998;132(5):876–8.CrossRefPubMedGoogle Scholar
  33. Hilfenhaus JW, Gregersen JP, Mehdi S, Volk R. Inactivation of HIV-1 and HIV-2 by various manufacturing procedures for human plasma proteins. Cancer Detect Prev. 1990;14(3):369–75.PubMedGoogle Scholar
  34. Hino S, Katamine S, Miyata H, Tsuji Y, Yamabe T, Miyamoto T. Primary prevention of HTLV-I in Japan. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;13 Suppl 1:S199–203.CrossRefPubMedGoogle Scholar
  35. Human Milk Banking Association of North America. Guidelines for the establishment and operation of a donor human milk bank; 2005. From
  36. Humphrey JH, Marinda E, Mutasa K, Moulton LH, Iliff PJ, Ntozini R, Chidawanyika H, Nathoo KJ, Tavengwa N, Jenkins A, Piwoz EG, Van de Perre P, Ward BJ, Z. s. group. Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study. BMJ. 2010;341:c6580.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Hunt KM, Foster JA, Forney LJ, Schutte UM, Beck DL, Abdo Z, Fox LK, Williams JE, McGuire MK, McGuire MA. Characterization of the diversity and temporal stability of bacterial communities in human milk. PLoS One. 2011;6(6):e21313.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Israel-Ballard K, Chantry C, Dewey K, Lonnerdal B, Sheppard H, Donovan R, Carlson J, Sage A, Abrams B. Viral, nutritional, and bacterial safety of flash-heated and pretoria-pasteurized breast milk to prevent mother-to-child transmission of HIV in resource-poor countries: a pilot study. J Acquir Immune Defic Syndr. 2005;40(2):175–81.CrossRefPubMedGoogle Scholar
  39. Israel-Ballard K, Coutsoudis A, Chantry CJ, Sturm AW, Karim F, Sibeko L, Abrams B. Bacterial safety of flash-heated and unheated expressed breastmilk during storage. J Trop Pediatr. 2006;52(6):399–405.CrossRefPubMedGoogle Scholar
  40. Israel-Ballard K, Donovan R, Chantry C, Coutsoudis A, Sheppard H, Sibeko L, Abrams B. Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. J Acquir Immune Defic Syndr. 2007;45(3):318–23.PubMedGoogle Scholar
  41. Khadse S, Hiremath A. Human milk bank: where every precious drop counts. Med J West India. 2013;41(1):45–7.Google Scholar
  42. Kumar RM, Shahul S. Role of breast-feeding in transmission of hepatitis C virus to infants of HCV-infected mothers. J Hepatol. 1998;29(2):191–7.CrossRefPubMedGoogle Scholar
  43. Kurath S, Halwachs-Baumann G, Muller W, Resch B. Transmission of cytomegalovirus via breast milk to the prematurely born infant: a systematic review. Clin Microbiol Infect. 2010;16(8):1172–8.CrossRefPubMedGoogle Scholar
  44. Landers S, Hartmann BT. Donor human milk banking and the emergence of milk sharing. Pediatr Clin North Am. 2013;60(1):247–60.CrossRefPubMedGoogle Scholar
  45. Landers S, Updegrove K. Bacteriological screening of donor human milk before and after Holder pasteurization. Breastfeed Med. 2010;5(3):117–21.CrossRefPubMedGoogle Scholar
  46. Lawrence RA. Storage of human milk and the influence of procedures on immunological components of human milk. Acta Paediatr Suppl. 1999;88(430):14–8.CrossRefPubMedGoogle Scholar
  47. Liebhaber M, Lewiston NJ, Asquith MT, Olds-Arroyo L, Sunshine P. Alterations of lymphocytes and of antibody content of human milk after processing. J Pediatr. 1977;91(6):897–900.CrossRefPubMedGoogle Scholar
  48. Lockman S, Creek T. Acute maternal HIV infection during pregnancy and breast-feeding: substantial risk to infants. J Infect Dis. 2009;200(5):667–9.CrossRefPubMedGoogle Scholar
  49. Lucas A, Roberts CD. Bacteriological quality control in human milk-banking. Br Med J. 1979;1(6156):80–2.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Lucas A, Gore SM, Cole TJ, Bamford MF, Dossetor JF, Barr I, Dicarlo L, Cork S, Lucas PJ. Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Arch Dis Child. 1984;59(8):722–30.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Lucas A, Morley R, Cole TJ, Gore SM, Davis JA, Bamford MF, Dossetor JF. Early diet in preterm babies and developmental status in infancy. Arch Dis Child. 1989;64(11):1570–8.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Lucas A, Morley R, Cole TJ, Gore SM, Lucas PJ, Crowle P, Pearse R, Boon AJ, Powell R. Early diet in preterm babies and developmental status at 18 months. Lancet. 1990;335(8704):1477–81.CrossRefPubMedGoogle Scholar
  53. Lucas A, Morley R, Cole TJ, Gore SM. A randomised multicentre study of human milk versus formula and later development in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994;70(2):F141–6.CrossRefPubMedPubMedCentralGoogle Scholar
  54. Macdonald LE, Brett J, Kelton D, Majowicz SE, Snedeker K, Sargeant JM. A systematic review and meta-analysis of the effects of pasteurization on milk vitamins, and evidence for raw milk consumption and other health-related outcomes. J Food Prot. 2011;74(11):1814–32.CrossRefPubMedGoogle Scholar
  55. Marin ML, Arroyo R, Jimenez E, Gomez A, Fernandez L, Rodriguez JM. Cold storage of human milk: effect on its bacterial composition. J Pediatr Gastroenterol Nutr. 2009;49(3):343–8.CrossRefPubMedGoogle Scholar
  56. Martin R, Heilig HG, Zoetendal EG, Jimenez E, Fernandez L, Smidt H, Rodriguez JM. Cultivation-independent assessment of the bacterial diversity of breast milk among healthy women. Res Microbiol. 2007;158(1):31–7.CrossRefPubMedGoogle Scholar
  57. Maschmann J, Hamprecht K, Weissbrich B, Dietz K, Jahn G, Speer CP. Freeze-thawing of breast milk does not prevent cytomegalovirus transmission to a preterm infant. Arch Dis Child Fetal Neonatal Ed. 2006;91(4):F288–90.CrossRefPubMedPubMedCentralGoogle Scholar
  58. McPherson RJ, Wagner CL. The effect of pasteurization on transforming growth factor alpha and transforming growth factor beta 2 concentrations in human milk. Adv Exp Med Biol. 2001;501:559–66.CrossRefPubMedGoogle Scholar
  59. Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol. 2009;29(1):57–62.CrossRefPubMedGoogle Scholar
  60. Miracle DJ, Szucs KA, Torke AM, Helft PR. Contemporary ethical issues in human milk-banking in the United States. Pediatrics. 2011;128(6):1186–91.CrossRefPubMedGoogle Scholar
  61. Montjaux-Regis N, Cristini C, Arnaud C, Glorieux I, Vanpee M, Casper C. Improved growth of preterm infants receiving mother’s own raw milk compared with pasteurized donor milk. Acta Paediatr. 2011;100(12):1548–54.CrossRefPubMedGoogle Scholar
  62. Moro GE, Arslanoglu S. Heat treatment of human milk. J Pediatr Gastroenterol Nutr. 2012;54(2):165–6.CrossRefPubMedGoogle Scholar
  63. O’Donovan D, Ariyoshi K, Milligan P, Ota M, Yamuah L, Sarge-Njie R, Whittle H. Maternal plasma viral RNA levels determine marked differences in mother-to-child transmission rates of HIV-1 and HIV-2 in the Gambia. MRC/Gambia Government/University College London Medical School working group on mother-child transmission of HIV. AIDS. 2000;14(4):441–8.CrossRefPubMedGoogle Scholar
  64. Pereira RN, Martins RC, Vicente AA. Goat milk free fatty acid characterization during conventional and ohmic heating pasteurization. J Dairy Sci. 2008;91(8):2925–37.CrossRefPubMedGoogle Scholar
  65. Perez PF, Dore J, Leclerc M, Levenez F, Benyacoub J, Serrant P, Segura-Roggero I, Schiffrin EJ, Donnet-Hughes A. Bacterial imprinting of the neonatal immune system: lessons from maternal cells? Pediatrics. 2007;119(3):e724–32.CrossRefPubMedGoogle Scholar
  66. Permanyer M, Castellote C, Ramirez-Santana C, Audi C, Perez-Cano FJ, Castell M, Lopez-Sabater MC, Franch A. Maintenance of breast milk Immunoglobulin A after high-pressure processing. J Dairy Sci. 2010;93(3):877–83.CrossRefPubMedGoogle Scholar
  67. Perrine CG, Scanlon KS. Prevalence of use of human milk in US Advanced Care Neonatal Units. Pediatrics. 2013;131(6):1066–71.CrossRefPubMedPubMedCentralGoogle Scholar
  68. Resti M, Azzari C, Mannelli F, Moriondo M, Novembre E, de Martino M, Vierucci A. Mother to child transmission of hepatitis C virus: prospective study of risk factors and timing of infection in children born to women seronegative for HIV-1. Tuscany Study Group on Hepatitis C Virus Infection. BMJ. 1998;317(7156):437–41.CrossRefPubMedPubMedCentralGoogle Scholar
  69. Ribeiro KD, Melo IL, Pristo AZ, Dimenstein R. The effect of processing on the Vitamin A content of human milk. J Pediatr (Rio J). 2005;81(1):61–4.CrossRefGoogle Scholar
  70. Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics. 2005;116(2):400–6.CrossRefPubMedGoogle Scholar
  71. Silvestre D, Ruiz P, Martinez-Costa C, Plaza A, Lopez MC. Effect of pasteurization on the bactericidal capacity of human milk. J Hum Lact. 2008;24(4):371–6.CrossRefPubMedGoogle Scholar
  72. Singhal A, Cole TJ, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet. 2001;357(9254):413–9.CrossRefPubMedGoogle Scholar
  73. Singhal A, Cole TJ, Fewtrell M, Lucas A. Breastmilk feeding and lipoprotein profile in adolescents born preterm: follow-up of a prospective randomised study. Lancet. 2004;363(9421):1571–8.CrossRefPubMedGoogle Scholar
  74. Stein H, Cohen D, Herman AA, Rissik J, Ellis U, Bolton K, Pettifor J, MacDougall L. Pooled pasteurized breast milk and untreated own mother’s milk in the feeding of very low birth weight babies: a randomized controlled trial. J Pediatr Gastroenterol Nutr. 1986;5(2):242–7.CrossRefPubMedGoogle Scholar
  75. Teixeira AG, Bicalho ML, Machado VS, Oikonomou G, Kacar C, Foditsch C, Young R, Knauer WA, Nydam DV, Bicalho RC. Heat and ultraviolet light treatment of colostrum and hospital milk: effects on colostrum and hospital milk characteristics and calf health and growth parameters. Vet J. 2013;197:175–81.CrossRefPubMedGoogle Scholar
  76. Terpstra FG, Rechtman DJ, Lee ML, Hoeij KV, Berg H, Van Engelenberg FA, Van’t Wout AB. Antimicrobial and antiviral effect of high-temperature short-time (HTST) pasteurization applied to human milk. Breastfeed Med. 2007;2(1):27–33.CrossRefPubMedGoogle Scholar
  77. Townsend CL, Peckham CS, Thorne C. Breastfeeding and transmission of viruses other than HIV-1. Adv Exp Med Biol. 2012;743:27–38.CrossRefPubMedGoogle Scholar
  78. Tully DB, Jones F, Tully MR. Donor milk: what’s in it and what’s not. J Hum Lact. 2001;17(2):152–5.CrossRefPubMedGoogle Scholar
  79. Untalan PB, Keeney SE, Palkowetz KH, Rivera A, Goldman AS. Heat susceptibility of interleukin-10 and other cytokines in donor human milk. Breastfeed Med. 2009;4(3):137–44.CrossRefPubMedGoogle Scholar
  80. Van Gysel M, Cossey V, Fieuws S, Schuermans A. Impact of pasteurization on the antibacterial properties of human milk. Eur J Pediatr. 2012;171(8):1231–7.CrossRefPubMedGoogle Scholar
  81. Van Zoeren-Grobben D, Schrijver J, Van den Berg H, Berger HM. Human milk vitamin content after pasteurisation, storage, or tube feeding. Arch Dis Child. 1987;62(2):161–5.CrossRefPubMedPubMedCentralGoogle Scholar
  82. Viazis S, Farkas BE, Jaykus LA. Inactivation of bacterial pathogens in human milk by high-pressure processing. J Food Prot. 2008;71(1):109–18.CrossRefPubMedGoogle Scholar
  83. Vieira AA, Soares FV, Pimenta HP, Abranches AD, Moreira ME. Analysis of the influence of pasteurization, freezing/thawing, and offer processes on human milk’s macronutrient concentrations. Early Hum Dev. 2011;87(8):577–80.CrossRefPubMedGoogle Scholar
  84. Wiktor SZ, Pate EJ, Rosenberg PS, Barnett M, Palmer P, Medeiros D, Maloney EM, Blattner WA. Mother-to-child transmission of human T-cell lymphotropic virus type I associated with prolonged breast-feeding. J Hum Virol. 1997;1(1):37–44.PubMedGoogle Scholar
  85. World Health Organization. Guidelines on HIV and infant feeding 2010: principles and recommendations for infant feeding in the context of HIV and a summary of evidence.
  86. Yamato K, Taguchi H, Yoshimoto S, Fujishita M, Yamashita M, Ohtsuki Y, Hoshino H, Miyoshi I. Inactivation of lymphocyte-transforming activity of human T-cell leukemia virus type I by heat. Jpn J Cancer Res. 1986;77(1):13–5.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of California DavisSacramentoUSA

Personalised recommendations