Mother's own milk, donor human milk, and preterm formulas in the feeding of extremely premature infants

Significant benefits to infant host defense, sensory-neural development, gastrointestinal maturation, and some aspects of nutritional status are observed when premature infants are fed their mothers' own milk. A reduction in infection-related morbidity in human milk-fed premature infants has been reported in nearly 1 dozen descriptive, and a few quasirandomized, studies in the past 25 years. Studies on neurodevelopmental outcomes have reported significantly positive effects for human milk intake on mental and motor development, intelligence quotient, and visual acuity compared with the feeding of formula. Human milk-fed infants also have decreased rates of rehospitalization after discharge. It is unclear how much human milk is needed to provide protection or at what postnatal age the protective effects maximize. The data suggest that a specific dose of milk may be needed to confer protection. A detailed composition analysis of milk obtained from women delivering before 30 weeks of gestation is needed to determine if the "immature" milk contains the same functional bioactive factors as more mature milk. Furthermore, lactation strategies should be sought that increase mother's own milk production.