Table 1

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

KnownsUnknowns
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

DEBMProbable

  • ▸ Improved feed tolerance

  • ▸ ↓NEC

  • ▸ Improved cardiovascular health

  • ▸ Improved cognition

  • ▸ Better bone mineral content


Definite

  • ▸ 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.