Balancing access to donor human milk: Rationing vs expanding use

Human milk is the optimal source of nutrition for infants; when mother's own milk (MOM) is unavailable, pasteurized donor human milk (DHM) is the preferred feeding alternative. DHM does not confer the same benefits as MOM, but as a human milk substrate, it remains distinctly unique from infant formulas. Although the evidence for DHM use is strong for high-risk preterm infants, especially very low birth weight infants, DHM's superiority over infant formula in improving clinical outcomes is less clear for other infant populations. Regardless, for some institutions, DHM use has been inconsistently extended to infants with congenital heart disease, gastrointestinal anomalies, neonatal opioid withdrawal syndrome, and other term or moderate and late preterm infants. Here, we describe the potential benefits and limitations to the expanded use of DHM as well as controversies related to access to DHM, including regulatory, financial, logistical, and distribution barriers.