Transforming Neonatal Nutrition: Impact of a Donor Human Milk Bank on Feeding Practices and Outcomes

Background Mother’s own milk is the optimal source of neonatal nutrition. When maternal milk is unavailable or insufficient, pasteurized donor human milk (DHM) is recommended for high-risk and low-birth-weight infants and is associated with a lower risk of necrotizing enterocolitis compared with formula. Objective To evaluate the impact of establishing a DHM bank on feeding practices and early outcomes in a tertiary neonatal unit in North Karnataka. Methods This retrospective before-and-after cohort study included inborn neonates admitted during the 12 months before and after milk bank establishment. Primary outcomes were time to initiation of enteral feeds and time to achievement of full enteral feeds. Secondary outcomes included DHM use, formula exposure, exclusive human-milk feeding at discharge, and feeding practices at early follow-up. Results Of 267 neonates screened, 260 were eligible (130 per epoch). After milk bank implementation, DHM use increased (113 vs. 79; P < .001) and formula exposure declined (4 vs. 21; P < .05). Mean time to first enteral feed reduced significantly (3.0 ± 3.7 vs. 10.3 ± 13.1 h; P < .001), as did time to full feeds (3.2 ± 4.4 vs. 4.0 ± 7.6 days; P = .04). Exclusive human-milk feeding rates improved at discharge ( P < .001) and remained higher at early follow-up ( P = .0016). Conclusions Establishment of a DHM bank facilitated earlier enteral feeding, reduced formula exposure, and strengthened exclusive breastfeeding practices, supporting its role as an effective strategy to improve neonatal nutrition in resource-limited settings.