Necrotizing enterocolitis (NEC) is a serious gastrointestinal problem primarily affecting premature infants. The optimal nutrition for premature infants is their mother’s milk (MOM), as it decreases the risk of significant complications of prematurity, most notably NEC¹. Pasteurized donor human milk (PDHM) is recommended when MOM is unavailable, insufficient, or contraindicated, as it is also associated with less NEC². Current human milk fortifiers are also recommended, as they do not increase NEC^3,4.  

However, mothers cannot always supply enough milk for their infants, and there is currently not enough PDHM in the United States for all premature infants. The best way to decrease NEC is to promote early and frequent milk expression, skin-to-skin contact, and direct breastfeeding when appropriate by the healthcare team. Adopting public policies that increase mothers' milk supply for these infants, such as paying for and ensuring access to designated NICU lactation support and effective breast pumps, is essential. Additionally, public policies to financially support mothers, such as paid maternity leave and tax credits for the time and effort to supply milk for their sick babies, are necessary. 

Some families are not able to feed their babies MOM and/or may choose not to use or do not have adequate access to PDHM. Though not ideal, in these situations, artificial breast milk substitutes (or infant formula) may be the only option available to feed these infants. Infant care management should be based on shared decision-making by the clinician and family based on all the available evidence and resources. 

Public policies are needed to expand access to PDHM and improve governmental and private financial support for donor milk banks. As only human milk is associated with the best outcomes for infants, formula companies, hospitals, and medical organizations should adopt the WHO International Code of Marketing of Breast-milk Substitutes and refrain from advertising and promoting infant formula to families when it is not medically necessary and when it is not the recommended best option for infant feeding. 

Written on behalf of the Academy of Breastfeeding Medicine by: 

Lawrence Noble, MD 
Department of Pediatrics 
Icahn School of Medicine at Mount Sinai and New York City Health & Hospitals 
Elmhurst, New York, NY, USA 

Lori B. Feldman-Winter, MD MPH FABM NABBLM-C 
Department of Pediatrics 
Cooper University Healthcare 
Cooper Medical School of Rowan University 
Camden, NJ, USA 

Ann Kellams, MD IBCLC FABM FAAP NABBLM-C 
Professor of Pediatrics 
Vice Chair of Clinical Affairs, Department of Pediatrics 
University of Virginia 
Charlottesville, VA, USA 

Adora Okogbule-Wonodi, MBBS FAAP 
Clinical Associate Professor of Pediatrics & Child Health/Neonatology 
Howard University College of Medicine/Howard University Hospital 
Washington, DC, USA 

Julie Ware, MD MPH IBCLC NABBLM-C FABM FAAP
Department of Pediatrics 
Cincinnati Children’s Hospital Medical Center 
University of Cincinnati College of Medicine 
Cincinnati, OH, USA