For a mother, expressing a few extra millilitres of breast milk may seem like a small act. But for the parents of a premature or critically ill newborn, those millilitres can mean nourishment for their baby.
Human milk banks are built around this simple exchange. Mothers who have more milk than their own babies need can donate their surplus to a certified milk bank, where it undergoes screening, pasteurisation, testing and controlled storage before being provided to vulnerable newborns according to medical need.
At Surya Mother & Child Super Speciality Hospital in Pune, for instance, the hospital says its human milk bank has collected 1,203 litres and 531 ml of breast milk from 1,176 donor mothers since it opened in January 2023.
A newborn's mother’s own milk remains the preferred source of nutrition. But there can be a gap between what a baby needs and what a mother is temporarily able to provide.
Why is this important?
This is particularly common in neonatal intensive care units. Mothers may be recovering from a difficult delivery, dealing with delayed lactation, separated from their babies, unwell, or struggling to express sufficient milk in the early days after birth. A premature baby may also require feeding before breastfeeding has been successfully established. In such circumstances, pasteurised donor human milk can provide a temporary bridge.
Indian human milk banking guidance places a clear hierarchy on infant feeding: breastfeeding and the mother’s own milk are preferred; when the mother’s milk is unavailable or insufficient, appropriately processed donor human milk can be used, particularly for vulnerable babies.
“Feeding has to be planned as carefully as any other treatment” for a premature or critically ill newborn, says Dr Amita Kaul, HOD, Senior Consultant, Paediatrics, Neonatology and Pediatric Intensive Care Services, Surya Mother and Child Super Speciality Hospital, Pune. “Donor human milk supports the baby while the mother recovers or builds her own supply. For the donor, it may be a small quantity of surplus milk, but for another family, it can become an important part of their baby’s care,” she added.
Human milk contains nutrients as well as a range of bioactive components that support an infant's developing immune and digestive systems. These benefits are particularly relevant for babies born prematurely or with very low birth weight.
What are the challenges?
One of the serious complications doctors worry about in extremely vulnerable newborns is necrotising enterocolitis (NEC), a potentially life-threatening inflammatory disease of the intestine that predominantly affects premature and very small babies. It can lead to severe infection, intestinal damage and, in some cases, surgery.
Research from India has also highlighted the potential importance of human milk banking. In one observational study involving very low birth weight babies, the introduction of an in-house human milk bank was associated with a decline in definite and advanced NEC from 9.4 to 1.76 per cent. Exclusive human milk feeding at discharge increased from 30.2 to 72.6 per cent.
Such findings need to be interpreted in the context of the overall care provided to premature babies, rather than attributing outcomes to milk banking alone. But they underline why access to human milk is considered an important component of neonatal care.
The success of a milk bank ultimately depends on donor mothers. Many mothers who donate are already breastfeeding successfully and find themselves producing more milk than their own babies require. With appropriate counselling, screening and collection practices, this surplus can be directed towards babies whose mothers cannot currently provide enough milk.
Dr Manisha Khalane, Lactation Consultant, says mothers often need support themselves before they can become donors. “Many mothers want to breastfeed but need help in the first few days. Our role is to support them without pressure, help them express and store milk safely, and guide eligible mothers who have surplus milk to donate. A mother’s surplus milk can help another baby through a very vulnerable period,” she says.
That support is important because breastfeeding does not always get off to an easy start. A baby may not latch properly, milk expression may initially be difficult, or a mother may become anxious when her milk does not appear to be flowing as expected.
Lactation counselling can help mothers understand that needing assistance does not mean they have failed at breastfeeding.
There is an important distinction between milk donation through an accredited human milk bank and informal milk sharing.
Donated milk intended for vulnerable newborns needs to be collected, screened, processed and stored under controlled conditions. Prospective donors undergo medical history assessment and infection screening. At the milk bank, the donated milk is pasteurised and tested before being stored and subsequently prescribed according to the baby's medical requirements.
This process is designed to minimise potential risks while retaining as many of the beneficial components of human milk as possible. For the recipient baby, donor milk is therefore not simply another mother's expressed milk. It is milk that has passed through a regulated safety process and is provided within a clinical setting.
For parents of a premature or critically ill newborn, feeding can become a source of anxiety. They may be coping simultaneously with a baby on respiratory support, multiple medical procedures and uncertainty about when their child will be able to breastfeed.
Having access to screened donor milk can remove one layer of that uncertainty while the mother works towards establishing or increasing her own supply. At the same time, the donor mother becomes part of a larger circle of care without compromising the central message that her own baby's nutritional needs come first.
The larger challenge, say experts, is awareness among mothers about early lactation support, among families about the role of milk banks, and among healthcare providers about timely referral and counselling.
Milk banks ensure what might otherwise be surplus can become a carefully processed resource for a newborn who needs it most.
For a premature baby, that surplus may amount to only a few feeds. But sometimes, a few feeds can make a significant difference.
