Storage and Use of Human Milk in Neonatal Intensive Care Units


  • 1.

    Human milk is an important source of nutrients, immunologic factors, and pre- and probiotic factors for preterm and critically ill infants for up to 6 months after birth.

  • 2.

    Human milk has positive effects on enhanced maturation of vital organs such as the brain and gastrointestinal system and on immunity, and it is also known to protect at-risk infants against neonatal morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity.

  • 3.

    Because mother’s own milk is not always available for all critically ill infants, neonatal intensive care units (NICUs) have/are developing storage facilities for the storage, screening, processing, and careful use of human milk in ill infants.

  • 4.

    In this chapter, we have summarized the information/guidelines for the development of physical infrastructure and human resources for milk storage units in NICUs.

  • 5.

    There is a need for continued education of mothers about the importance of human milk and its storage, screening for infectious agents, and measures to improve safety of infant feeding with mother’s own or stored donor milk.


Human milk has a unique composition, and consequently, has unique bioactive properties that differ from milk from other mammals ( Fig. 17.1 ). Breast milk not only meets complete nutritional needs of a newborn infant ( Fig. 17.2 ) up to 6 months but also plays a vital role in development of the brain and immune system, and it has been constantly emphasized in literature. In-depth analyses show unique structural patterns in human milk-borne carbohydrates, which may have far-reaching effects and even after the patterns of gut microbial colonization extending into later infancy and beyond ( Fig. 17.3 ). All these attributes make breastfeeding the single most cost-effective intervention to reduce infant mortality across the globe. Although all newborn infants benefit from breast milk, not all are able to breastfeed at birth, which majorly includes preterm and low birth infants. The benefits of breast milk remain irreplaceable in preterm neonates. Prevention of prematurity-related morbidities such as necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity; better intestinal maturity; and improved neurodevelopmental outcomes are a few advantages. , Succinctly, the most vulnerable population of newborns is at the greatest risk of increased mortality and morbidity and is not able to receive the benefits of breast milk. However, initiation and maintenance of mother’s own milk (MOM) are of global concern in neonatal intensive care units (NICUs). The World Health Organization and European Society for Paediatric Gastroenterology, Hepatology, and Nutrition recommend pasteurized donor human milk as the next best option if MOM is not available. This chapter outlines the basic requirements and principles for developing facilities in various NICUs for storage of MOM, and if possible, milk from mothers willing to share if there are volumes more than those needed for their own infants. For donated milk, a set of procedures needs to be developed similar to those used in larger milk banks to ensure safety from any infectious agents.

Fig. 17.1

Human milk carbohydrates show unique structural characteristics, which may impart important short- and long-term beneficial effects .

Upper row: The disaccharide lactose, is the most abundant carbohydrate found in human milk and the core for human milk oligosaccharides. Rows 2 to 7: Selected examples of simple human milk oligosaccharide (hMOS) structures. Shown are two fucosylated structures (2′-FL and 3′-FL), two sialylated (acidic) structures (3′-SL and 6′-SL), and two precursor molecules without fucose or sialic acid. Rows 8 to 9: Two commercially available prebiotic carbohydrates are shown (fructo-oligosaccharide [FOS] and galacto-oligosaccharide [GOS]).

(Morrow, Newburg, Human milk oligosaccharide. Gastroenterology and Nutrition: Neonatology Questions and Controversies, Chapter 4 , 43–57.)

Fig. 17.2

Changes in Milk Composition Over Time in Term (FT, 37–41 Weeks), Preterm (PT, 30–36 Weeks), and Very Preterm (VPT, <28–30 Weeks) Infants .

(A) Nutrients. (B) Bioactive molecules. EGF, Epidermal growth factor; GAG, glycosaminoglycans; IgA, immunoglobulin A; IL 6, interleukin 6; IL 10, interleukin 10; TNF alpha, tumor necrosis factor alpha.

(Adapted from: Reproduced with permission and minor modifications from Underwood MA. Human milk for the premature infant. Pediatric Pediatr Clin North Am . 2013;60[1]:189–207.)

Fig. 17.3

Human Milk Microbiota Composition and Comparison Between Breastfeeding and Formula-Feeding Microbiota .

Metagenome analysis of human milk shows that the human milk microbiota is mainly dominated by Staphylococcus , Pseudomonas , and Edwardsiella , but other groups are also represented in minor amounts. Breastfed and formula-fed infants have different bacterial populations, which seems to modulate the susceptibility of noncommunicable diseases such as allergy and/or obesity during infancy and/or in adult life. E. coli , Escherichia coli .

(Adapted from: Reproduced with permission and minor modifications from Gomez-Gallego et al. The human milk microbiome and factors influencing its composition and activity. Semin Fetal Neonatal Med . 2016;21[6]:400–405.)


Human milk storage facilities in NICUs store, screen, process, and use human milk to feed the infants. These units promote, protect, and support breastfeeding by providing safe and appropriate storage to provide high-quality human milk to premature and critically ill infants. Such units also help prevent waste of this important resource during periods when the infant cannot be fed due to medical reasons.

Infrastructure of Human Milk Storage Units in NICUs

The use and processing of human milk for use in the newborn infant units and NICUs is summarized in Fig. 17.4 . In the following sections, we describe the structural and functional needs for developing a human milk storage unit in a hospital. We realize that the chapter is relatively weighted toward the policies and procedures needed for processing donated milk, but these details are needed to prevent infections and transmission of unknown toxins and to ensure safety when an infant is fed with donated milk. The procedures to ensure safety of using mothers’ own and donated milk have been defined but need periodic reevaluation ( Fig. 17.5 ).

Fig. 17.4

Use and Processing of Mother’s Own and Donor Milk for Use in Newborn Units and Neonatal Intensive Care Units (NICUs) .

The processing and storage of donor milk is known to cause some changes in the nutrient composition.

(Adapted from: Reproduced with permission and with minor modifications from Colaizy T. Effects of milk banking procedures on nutritional and bioactive components of donor human milk. Sem Perinat . 2021;45:151382.)

Fig. 17.5

Safety of Stored Maternal and Donor Milk .

Banked human milk and feeding preterm infants with human milk. BW, Birth weight; GA, gestational age; S aureus, Staphylococcus aureus .

(Adapted from: Reproduced with permission and minor modifications from Picaud J-C, Buffin R. Human milk—treatment and quality of banked human milk. Clin Perinatol . 2017;44:95–119.)


There are no standard guidelines or recommendations on the minimum or maximum space required for a milk bank, but it is considered to be approximately a 250-square-foot room, which accommodates milk bank equipment, a work area for technicians, and records storage. A breast milk expression room should be separate, which provides sufficient privacy to the mothers.



To pasteurize milk, the Holder method is recommended (heat treatment of milk at 62.5°C for 30 minutes). It can be done by an automated pasteurizer or by the shaker–water bath (manual method), a less-expensive method that can be used in resource-limited settings. Another method of pasteurization is flash heat treatment (high temperature, short time; 72°C for 16 seconds) or ultraviolet irradiation, which is not being used very commonly.

Deep Freezer

Milk is stored at −20°C in closely monitored refrigerators. A deep freezer with an automatic temperature display is desirable. For donated milk, two deep freezers are required, one to keep postpasteurized milk awaiting culture and another to keep culture-negative milk, ready for disbursement.


A refrigerator is used when the collected milk cannot be used immediately and needs to be stored for 24 hours or longer. Donated milk should be pooled and pasteurized. Pasteurized milk is also kept in a refrigerator for thawing overnight before disbursement. Either two separate units should be used or clear demarcation should be present to prevent any confusion in usage of pre- and postpasteurization milk.

Hot Air Oven/Autoclave

Human milk storage units should have individual hot air ovens, autoclaves, or centralized sterile service departments to sterilize the containers used for milk expression, storage, pasteurization, and if needed, transport of milk.

Breast Milk Pump

Hospital-grade electrical breast pumps ( Fig. 17.6 ) are preferred, as these are more comfortable, less painful, and can be used for expression of larger volumes. In resource-limited settings and for home expression, manual breast pumps are recommended. Cleaning and sterilization should be done as per the manufacturer’s manual.

Sep 9, 2023 | Posted by in PEDIATRICS | Comments Off on Storage and Use of Human Milk in Neonatal Intensive Care Units

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