Table 1

The knowns and unknowns about human milk and its use in preterm infants

Human milk
  • More rapid achievement of full feeds

  • ↓NEC

  • ↓Sepsis

  • Improved brain development and neurodevelopmental outcome

  • ↓Hospital admission up to 30 months

  • Possibly ↓ROP

  • ↓Cost of care

  • Many effects dose-related

  • Nutrient provision improved with HMF

  • Uncertainty of size of effect on morbidities in context of modern neonatal care

  • What is/are the critical period(s) of exposure

  • Variability in composition

  • Effect on nutrient composition of standing, refrigeration and freeze-thawing

  • Possibility of sensitisation to foreign protein with HMF

  • Optimal approach to risk of transmission of viruses and bacteria

  • Improved feed tolerance

  • ↓NEC

  • Improved cardiovascular health

  • Improved cognition

  • Better bone mineral content

  • Less nutrient rich than preterm MEBM

  • Bacteria and blood borne viruses inactivated by pasteurisation

  • Pasteurisation reduces concentration of immune factors

  • Uncertain size of effect on preterm morbidities of DEBM versus MEBM

  • Possible techniques to inactivate viruses with less destruction of nutrients

  • Variability in composition

  • Uncertainties about effect of maternal nutrient and toxin intake

  • Small concern about emerging pathogens

  • DEBM, donor breast milk; HMF, human milk fortifier; MEBM, mother's expressed breast milk; NEC, necrotising enterocolitis.