Donor Milk Research Articles

Breast milk sharing practices in emergency settings

Abstract Background In emergencies, breast milk sharing becomes essential to sustain infant nutrition when access to maternal breastfeeding is disrupted. This study examines donor motivations and assesses the impact of such initiatives on infant health outcomes during wartime. Methods This qualitative study investigated a community of breast milk donors on a Facebook platform for the month following the start of the war on October 7, 2023. We investigated two main groups participating in breast milk sharing through reflective thematic analysis of social media messages. Results A count of posts one month before and after October 7 revealed a doubling in post frequency post-7/10, emphasizing the surge in war-related posts. Two main themes emerged concerning the war: 1. Infant needs: Posts addressed various infant needs, including general necessities and those specific to war-related situations. Requests for milk sharing emerged from the second day of the war, particularly for infants whose mothers were missing or injured. Government information from the National Human Milk Bank was shared within these Facebook groups, encouraging donations for these infants. 2. Donor Motivation: Posts reflected both non-war-related and war-related motivations, with a notable emphasis on the latter. Authors, including both women and men, actively promoted the donation of human milk to conflict-affected areas. Suggestions included pumping milk specifically for war-affected infants or offering frozen human milk. Some posts also offered to collect and deliver human milk to needy infants within the affected regions. Conclusions Post frequency doubled in both Facebook groups compared to the previous month, mainly focusing on war-related topics, indicating an increased drive to share human milk with those affected by the conflict. Key messages • Breast milk sharing, crucial in emergencies, analyzed via social media, sheds light on donor motivations and impacts on infant health during conflicts. • This qualitative study investigated a community of breast milk donors on a Facebook platform for the month following the start of the war on October 7, 2023.

Factors Associated with Inequities in Donor Milk Bank Access Among Different Hospitals.

Objective: Donor human milk (DHM) can provide many benefits to neonates. This study examines access to DHM and how structural barriers may exacerbate inequities. Study Design: The median test and analysis of variance test were used to compare the distribution of maternal race/ethnicity and insurance status variables with DHM access for California neonatal intensive care units (NICUs) in 2021. Results: Across 124 NICUs, those serving a higher percentage of white families were more likely to have access to DHM (p = 0.04). NICUs with a higher percentage of Hispanic families were less likely to have access to DHM (p = 0.03). Hospitals that had higher proportions of uninsured patients were also less likely to have access to DHM (p = 0.015). Conclusion: Inequities in DHM access and use among NICU infants begin at the structural level. Policies that reduce barriers to DHM access may reduce health inequities for Hispanic and uninsured families.

Interventions to prevent Neonatal Healthcare-associated Infection: a systematic review of RCT

Abstract Background Healthcare-acquired infections (HAI) in neonatal intensive care unit (NICU) specifically refer to infections that occur in newborn infants within the healthcare environment. Preterm infants, often more vulnerable to infections, in the NICU may be exposed to various medical interventions, devices, and environments that can increase the risk of infections. This systematic review aims to evaluate the effectiveness of interventions proposed to prevent neonatal healthcare-associated infections. Methods PubMed, Scopus and Web of Science databases were searched to identify any RCT study coming from high income countries, published from 2004, that investigated the efficacy of any intervention to prevent HAI in NICU. All type of HAI were considered. Results A total of seven studies were included (2 from USA, 5 from UE). Three studies focused on: administration of donor milk; probiotic Bifidobacterium breve; intravenous Staphylococcus aureus immune globulin; all failed to demonstrate any protective action. Of the four remaining studies that investigate different aspect of the vascular catheterization process only two lead a a statistical significant reduction of HAI. Garland et al. demonstrate in 85 neonates how vancomycin-heparin lock solution is capable to reduce catheter related blood stream infection (CRBSI) 8/43 neonates (18.6%) in the control group vs 0/42 in the vancomycin-heparin-lock group (P = 0.006). Bertini et al. demonstrate in 86 preterm infants how utilization of AgION catheter in Umbelical vein catheterization (UVC) lead to CRBSI rate reduction (2 vs. 22%; p = 0.005), shorter hospital stay (p = 0.04), lower case fatality rate due to Blood stream infection (p = 0.01). Conclusions Among the proposed methodology only the one acting on the catheterization process provide a statistical significant reduction of HAI onset. Widespread observation of proposed protocol may results in reduction of HAI in NICU. Key messages • Modfiication on the catheterization process provide a statistical significant reduction of HAI onset. • Knowing these measures assure reduction of HAI.

41 Neonatal outcomes with exclusive breast milk in infants with gastroschisis: A systematic review and meta-analysis

Abstract Background Infants with gastroschisis may experience prolonged stays in hospital as they transition from parenteral nutrition to enteral feeds. Some studies suggest that patients who receive exclusive breast milk experience better outcomes than those who receive supplemental or exclusive formula. These findings are inconsistent and the evidence for exclusive breast milk remains uncertain. Objectives To systematically review and meta-analyze the effectiveness of exclusive breast milk in infants with gastroschisis. Design/Methods We searched Medline, Embase, and Cochrane without language restriction from inception until June 2023. Manual searches of trial registries and reference lists of relevant articles were also performed. We included studies that assessed the effectiveness of exclusive breast milk compared to formula among infants with gastroschisis. Title, abstract, full-text screening, and data extraction were completed by two independent reviewers. The Newcastle-Ottawa Scale was used to assess the risk of bias. Our outcomes of interest were time to full enteral feeds, days of parenteral nutrition, length of stay, necrotizing enterocolitis (NEC), cholestasis, and mortality. RevMan was used to meta-analyze treatment effects using a random effects model whenever possible. Summary statistics were reported as relative risk (RR) with 95% confidence intervals (95% CI). Results We identified 130 studies of which six were selected for review. All included studies were observational and retrospective. Only 3 studies (n=3211 participants) reported outcome data that were amenable to meta-analysis. All participants received exclusive breast milk (n=1009) or supplemental or exclusive formula (n=2202). Exposure to exclusive breast milk was associated with a lower risk of mortality compared to those who received formula (unadjusted RR=0.36; 95% CI: 0.13-0.96, 2 studies, n=3157, I2=0%). Exposure to exclusive breast milk was not associated with a decrease in NEC (unadjusted RR=0.20; 95% CI: 0.03-1.14; 3 studies, n=3211, I2=0%). The primary source of bias among included studies was lack of adjustment for confounders. We identified one randomized controlled trial comparing exclusive breast milk to formula. This study was stopped due to low recruitment. Conclusion The use of exclusive breast milk among infants with gastroschisis may be associated with a reduction in mortality; however, this estimate is based on small numbers from observational studies. Estimates may change as more data become available. Further research is needed to establish best feeding practices, including the role of human donor milk.

Sociodemographic and Psychological Factors Influencing Human Milk Donation: A Cross-Sectional Study of 420 Lactating Mothers in Vijayapura

Sociodemographic and Psychological Factors Influencing Human Milk Donation: A Cross-Sectional Study of 420 Lactating Mothers in Vijayapura

Survey on the State, Potential, and Obstacles of the Digital Transformation in Human Milk Banks

Digitalization of human milk banking was examined in a survey among participants of the largest German-speaking symposium for human milk banks. Of the 100 participants, 47% were nurses, 23% were physicians, and 3% were midwives. The overwhelming majority (96%) desired more digitalization in their milk bank. The best-digitized processes were clinical results from donors, milk labeling, and milk orders. At the same time, a discrepancy between the maximum conceivable potential and the current implementation of digital transformation became evident. The survey revealed most participants use in-house digital solutions. Potential main advantages of digitalization were cited as efficiency gains, while implementation efforts and security concerns, particularly power outages and cyberattacks, were seen as disadvantages. Financial restraints, personnel shortage, resistance from local IT departments, and legal concerns were perceived as the biggest barriers. Despite these challenges and a critical examination of the disadvantages, the participants expressed strong optimism and a desire for further digitalization in the human milk bank sector.

Peer-to-Peer Human Milk Sharing Through Social Media Groups: The Experiences of Women Donors and Recipients in Hong Kong.

To explore the lived experience of donors and recipients involved in peer-to-peer human milk donation. An exploratory descriptive qualitative study. Semi-structured interviews were conducted between November 2022 and April 2023. A total of 50 women consisting of 34 donors and 16 recipients were recruited using purposive sampling from specific social media groups in Hong Kong that focus on breast milk donation and sharing. Data were analysed based on thematic analysis. Five key themes were identified in this study: Motivation; Milk sharing as a social act; Not a Norm; Recommendation to formal milk banks; and Formal donation as the preferred route. The findings indicate informal milk sharing is seen as an inferior alternative to formal milk donation systems. The establishment of formal milk banks is viewed as a way to address the shortcomings of informal sharing. The findings have implications for the healthcare field, particularly in improving the experiences of those involved in informal milk sharing. The insights gained from the experiences of informal milk sharers can directly inform and enhance the services provided by formal milk banks. Given the growing prevalence of online informal milk sharing, healthcare professionals should enhance their understanding of this practice. However, the practice has remained understudied, particularly in Asian region. This study brings together the experiences of both milk donors and recipients, providing a comprehensive view on the phenomenon. The Standards for Reporting Qualitative Research (SRQR). No patient or public contribution.

Maternity care practices supportive of breastfeeding in U.S. advanced neonatal care units, United States, 2022.

To describe breastfeeding-supportive practices in U.S. maternity hospitals with advanced neonatal care units (ANCU). Using 2022 mPINC data, we calculated the percent of hospitals reporting (1) breastfeeding-supportive practices for "most" (≥80%) mother-baby dyads in ANCUs, by hospital demographic characteristics and (2) infant receipt of mother's own milk or donor milk at any time while in the ANCU, by ANCU level. More than 90% of hospitals reported that "most" mothers (≥80%) were advised on some breastfeeding-supportive practices. Fewer hospitals reported that "most" mothers expressed milk within one hour of birth (37%) or that kangaroo care was practiced for "most" eligible newborns (63%). Receipt of mother's own milk varied by unit level and state. Breastfeeding-supportive practices requiring the technical competency of healthcare providers (e.g., early milk expression, kangaroo care) are less likely to be implemented in ANCU settings compared to practices centered around providing advice or education.

Perspectives of healthcare workers on the acceptability of donor human milk banking in Southwest Nigeria

BackgroundThe World Health Organization prioritizes Mother’s Own Milk (MOM) or donor human milk (DHM) when MOM is unavailable or insufficient. It is also important for healthcare workers (HCWs) to provide adequate support, information, and education to mothers to help improve their milk production and breastfeeding experience. DHM is scarce in developing countries, prompting a need for understanding health workers’ perspectives.MethodsThis cross-sectional study, conducted in 2021 in Ekiti State, Nigeria, examined the knowledge and attitudes of HCWs regarding human milk banking. A sample of 321 participants from government-owned hospitals completed a self-administered questionnaire.ResultsOf the 321 participants (84.7% response rate), the majority were females (69.2%), aged 30–39 (32.1%), Christian (91.9%), and employed in tertiary hospitals (91.9%). About 65% of the HCWs believe that HMB is a safe practice and 42% believe that the DHM has the same quantity of immunological factors as fresh human milk. While 80.4% displayed good DHM knowledge, attitudes varied. The HCWs profession influenced their attitudes and a higher proportion of all female HCWs (71%), except for health assistants (65.4%), expressed willingness to donate their breast milk if needed. Among males HCWs, the majority of those who were doctors (82.8%) and pharmacists (62.5%) expressed willingness to support their spouses to donate breast milk, and they also had higher acceptance of DHM for their infants. In all, more than 80% of the HCWs will encourage mothers to donate their milk and feed babies under their care with DHM, but only 47% would accept DHM to feed their own children. Health assistants had less favourable views, and negative perceptions were linked to the internet and media sources.ConclusionsThe study highlights health workers’ awareness of DHM but indicates a reluctance to fully embrace it, especially among health assistants. The need for targeted education programs, to address knowledge gaps and negative perceptions, is crucial for the successful implementation of human milk banks in Nigeria. Overcoming challenges, such as safety concerns and sociocultural influences, requires focused efforts from policymakers and healthcare institutions.

Study on Vitamin K Levels in Mature Milk of Chinese Lactating Mothers.

This study sought to understand the levels of vitamin K in the mature milk of Chinese lactating mothers, thereby providing a foundation for the development of appropriate intake (AI) of vitamin K for infants aged 0-5 months. Five hundred healthy lactating mothers were selected from the mature milk bank established by the Chinese Maternal and Infant Nutrition and Health Cohort by using a simple random sample procedure. Relevant information about lactating mothers and their infants was obtained by a questionnaire survey. Vitamin K1 and vitamin K2 (MK-4 and MK-7) in mature milk were determined by liquid chromatography-tandem mass spectrometry. The total concentration of vitamin K in mature milk was 4.50 (2.85-6.33) ng/mL. The concentrations of vitamin K1, vitamin K2, MK-4, and MK-7 were 2.81 (1.66-4.39) ng/mL, 1.37 (0.75-2.11) ng/mL, 1.20 (0.58-1.97) ng/mL, and 0.13 (0.08-0.19) ng/mL, respectively. The concentration of vitamin K1 was highest and the concentration of MK-7 was lowest. The concentrations of vitamin K2 and MK-4 in mature milk from the south were significantly higher than those in mature milk from the north. The total vitamin K, vitamin K2, and MK-4 concentrations in mature milk of lactating mothers residing in urban areas were higher than those in rural areas. There was a tendency for the concentration of total vitamin K and vitamin K1 to increase with the mother's age. Moreover, the concentration of MK-4 in mature milk was highest in summer, followed by spring and winter. The levels of vitamin K1 and MK-4 in mature milk were found to be affected by lactation stage; they were highest at 91-120 days and lowest at 31-60 days. Based on the concentration of vitamin K in mature milk found in this study, it is recommended that the appropriate intake of VK for Chinese infants aged 0-5 months is 3.49 μg/d (2.18 μg/d for VK1 and 1.06 μg/d for VK2).

Donor Milk Expression Habits: Can we Favor Hindmilk Banking for Extremely Preterm Infants?

Background: Extremely preterm infants often receive donor milk. Hindmilk, which is released more than 3 minutes after letdown, could be advantageous due to its elevated levels of fat and calorie density. Donor milk expression habits may influence milk composition but have not yet been investigated. This study aims to assess the practices of milk donors and the feasibility of hindmilk expression. Methods: Active milk donors in Québec were questioned using an online survey about their milk expression habits and whether hindmilk donation would be acceptable to them. Answers were analyzed using mixed methods. Results: Of 181 donors, 126 fully completed the questionnaire (70%); 57% reported expressing donated milk between breastfeeds; 15% reported simultaneously breastfeeding while expressing donated milk from the other breast; 12% reported breastfeeding their baby on each breast, then expressing donated milk (hindmilk). The majority (66%) would be willing to change their habits most or all the time to provide hindmilk for preterm infants. The main themes invoked by respondents in open-ended answers were altruism and gratitude for being able to help others. However, 15% commented on the complexity of milk expression or that adding further complexity might discourage them from donating. Conclusions: Expression practices are variable, which may lead to variability in donor milk composition. Most donors would agree to change their expression habits in favor of giving hindmilk to help the most fragile infants. More information is needed on how changing recommendations for milk expression might impact the supply and composition of donor milk.

Comparative analysis of different methods for protein quantification in donated human milk.

Human milk is the best option for feeding newborns, especially premature infants. In the absence of breast milk, milk from a human milk bank can be a suitable alternative. However, the nutritional content of human milk may be insufficient to meet these high requirements and milk fortification is needed. To facilitate the implementation of simpler and faster analyzers in neonatal healthcare facilities, this study focuses on the concordance analysis of two different analyzers, one based on mid-infrared and the other on ultrasound, in comparison to the Bradford method for determining protein concentration in human milk. Mature milk samples from donor mothers were collected and pasteurized at the Human Milk Bank of Barcelona and protein quantification was performed using mid-infrared (MIRIS-HMA), ultrasound (MilkoScope Julie27), and the classical Bradford reference methods. The intraclass correlation coefficient (ICC) with 95% confidence interval and Bland-Altman plots were used to assess the agreement between methods. The mean protein concentration of 142 milk samples calculated using MIRIS-HMA, MilkoScope, and the Bradford assay were 1.38, 1.15, and 1.19 g/100 ml, respectively. The ICC was 0.70 for MIRIS-HMA vs. Bradford and 0.37 for MilkoScope vs. Bradford. MIRIS-HMA obtained a better agreement with the Bradford technique and is a promising method for developing new devices based on MIR transmission spectroscopy principles. This study confirms how MIRIS-HMA can be used to accurately calculate the protein concentration of human milk.

Microbial profiling, antimicrobial resistance surveillance, and molecular detection of MecA gene in Staphylococcal strains from donor human milk: Insights from a milk bank investigation

PurposeDonor human milk (DHM) from milk banks provides vital nutrition to vulnerable infants. Understanding its microbial profile and antimicrobial resistance patterns is crucial for ensuring its safety and efficacy. This study aimed to profile the microbial composition, detect antibiotic resistance, and identify the presence of mecA gene in Staphylococcal strains from DHM samples. Materials and methodA total of 151 DHM samples were collected from a regional human milk bank in North India. Microbial identification was performed using MALDI TOF MS, and antimicrobial susceptibility testing was conducted using the disc diffusion method. Molecular methods, including PCR, were employed for mecA gene detection. ResultsThe study revealed a diverse microbial profile, with Staphylococcus species being predominant. Acinetobacter and Pseudomonas species were also prevalent, raising concerns due to their association with healthcare-associated outbreaks. High rates of antibiotic resistance were observed across both Gram-positive and Gram-negative bacteria, with resistance to commonly used antibiotics such as penicillin, clindamycin, erythromycin, and ceftriaxone. The mecA gene, associated with methicillin resistance, was detected in a significant proportion of Staphylococcal isolates. ConclusionThe study underscores the importance of rigorous microbial analysis and antimicrobial susceptibility testing in assessing the safety of DHM. The presence of diverse microbial species, including antibiotic-resistant strains and the mecA gene in Staphylococcal strains, emphasizes the need for stringent hygiene practices and continuous surveillance in milk banks. Implementing comprehensive screening protocols and adhering to best practices in milk handling and pasteurization are crucial for safeguarding the health of vulnerable infants reliant on donor milk.

Postnatal Development of the Circadian Rhythmicity of Human Pineal Melatonin Synthesis and Secretion (Systematic Review).

Introduction: According to current knowledge, at birth, the pineal gland and melatonin receptors are already present and the suprachiasmatic nucleus is largely functional, and noradrenaline, the key pineal transmitter, can be detected in the early foetal period. It is still unclear why the pineal gland is not able to start its own pulsatile synthesis and secretion of melatonin in the first months of life, and as a result, infants during this time are dependent on an external supply of melatonin. Method: The causes and consequences of this physiological melatonin deficiency in human infancy are examined in a systematic review of the literature, in which 40 of 115 initially selected publications were evaluated in detail. The references of these studies were checked for relevant studies on this topic. References from previous reviews by the author were taken into account. Results: The development and differentiation of the pineal gland, the pinealocytes, as the site of melatonin synthesis, and the development and synaptic coupling of the associated predominantly noradrenergic neural pathways and vessels and the associated Lhx4 homebox only occurs during the first year of life. Discussion: The resulting physiological melatonin deficiency is associated with sleep disorders, infant colic, and increased crying in babies. Intervention studies indicate that this deficiency should be compensated for through breastfeeding, the administration of nonpooled donor milk, or through industrially produced chrononutrition made from nonpooled cow's milk with melatonin-poor day milk and melatonin-rich night milk.

Cost of operating a human milk bank in the UK: a microcosting analysis

ObjectiveGlobally, demand for donor human milk (DHM) is increasing with WHO guidelines recommending DHM as the first line nutrition for premature infants in the absence or shortfall of maternal milk....

Exploring trends of macronutrients in Danish human donor milk

Exploring trends of macronutrients in Danish human donor milk

Donor human milk practice in Indonesia: a media content analysis.

Donor human milk (DHM) is recommended as the second-best alternative form of supplementation when a mother is unable to breastfeed directly. However, little is known about the experience of mothers and families in the communities regarding accessing and donating expressed breastmilk in Indonesia. This study aimed to identify the experience related to donor human milk in the society in Indonesia. A search was conducted through six main online news portals. The keywords used included "donor human milk," "expressed breastmilk," and "wet nursing" in the Indonesian language, Bahasa Indonesia. A total of 107 articles were found, but only 20 articles were included for analysis using a qualitative media content analysis approach. In the study, the following five themes were identified: (1) the whys and wherefores of donor human milk, (2) national and religious-based regulations, (3) recommendations from authorized organizations, healthcare professionals, and Islamic scholars, (4) the negative impact from the lack of national regulations, and (5) contradictory feelings among mothers. With the lack of detailed information on how to access or donate expressed human milk and the absence of a human milk bank in place, informal human milk sharing is inevitably occurring in the community. This has also raised concerns among authorized organizations, healthcare professionals, and Islamic scholars. Consequently, mothers, both donors and recipients, experienced negative impacts, which included contradictory feelings. Engaging with Islamic scholars and healthcare professionals to develop clear guidelines and regulations to enable mothers' and families' access and/or make contributions to DHM in a safe and accountable way is critical to prevent further problems from occurring in Indonesian society.

Achievements and Challenges in Breastfeeding During Two Years of War in Ukraine.

Background: This article informs about the state of breastfeeding in Ukraine after more than 2 years of war. The article presents important information on breastfeeding data, the widespread implementation of the baby-friendly hospital initiative, human milk banks working in difficult situations, the first overestimation of breast milk substitute needs, the International Code, and the presence of donations reaching an overburdened health system. It covers the training of health care professionals as well as counseling in wartime. Conclusion: It is a testimony of important work done on different levels of the Ukrainian population as well as among the aid agencies present and the health system to protect and support breastfeeding for infants and mothers' health in a war situation. The acquired breastfeeding knowledge through BFHI training of health care professionals and the whole package of BFHI measures is important for ensuring the health and survival of children.

Lactation Newsmakers: Documenting our History - Supporting Breastfeeding Exchange Relations by Building Equitable and Innovative Solutions: An Interview With João Aprigio Guerra de Almeida.

Professor Joao Aprigio Guerra de Almeida graduated in Food Engineering (UFV-1981) with a Master in Microbiology (UFV-1986) and a doctorate in Women's and Children's Health (Fiocruz/IFF, 1998) He is founder and coordinator of the Brazilian Human Milk Banks Network (Ministry of Health-Brasil/Oswaldo Cruz Foundation-Fiocruz, 1987 to 2024); Head of the National Reference Center for Human Milk Banks at the National Institute of Women, Children and Adolescent Health Fernandes Figueira-IFF (Fiocruz/IFF, 1987 to 2024); Executive Secretary of the Ibero-American Human Milk Banks Network Program (Ibero-American General Secretariat-SEGIB/Brazilian Cooperation Agency-ABC/MS-FIOCRUZ, 2008 to 2020); Coordinator of International Technical Cooperation in Human Milk Banks ABC/Fiocruz/MS (2005 to 2024); and Coordinator of the Human Milk Banks Network of the Community of Portuguese Speaking Countries - CPLP (2017 to 2024). He has been recognized with the Sasakawa Health Prize (World Health Organization [WHO], 2001); as Officer of the Order of Rio Branco (Presidency of the Federative Republic of Brazil, 2001); with Global Health Challenges and Responses of the South in Time of Crisis (WHO, 2009); as Commendator of the Order of Rio Branco-Ministry of Foreign Affairs/Presidency of the Federative Republic of Brazil (2018); and Dr LEE Jong-wook Memorial Prize for Public Health (WHO, 2020). His areas of activity include Public Health, breastfeeding, Human Milk Banks, Public Management, and International Technical Cooperation.

Increased enteral lipid supplementation is not associated with weight gain in extremely preterm infants with sufficient energy intakes.

Practices for fortifying human milk vary among neonatal intensive care units (NICUs). It is unclear whether enteral energy intake above 140 kcal/kg/day with increased fat supplementation leads to greater weight gain in breastmilk-fed extremely preterm (EPT) infants. Anthropometric and nutritional data were collected from clinical records for Swedish EPT infants born between gestational weeks 26 + 0 and 27 + 6. Included infants were treated at NICU A (n = 17) or NICU B (n = 39). The primary outcome was change in standard deviation (SD) scores (ΔSDS) for weight between postmenstrual weeks 29 + 0 and 34 + 0. At birth, the mean gestational age was 26.9 (±0.45 SD) weeks and the mean birthweight was 969 (±107 SD) g. Between postmenstrual weeks 29 + 0 and 33 + 6, the energy intake was significantly higher at NICU B: mean (SD) 149 (±14.9) versus 132 (±11.2) kcal/kg/day, p ≤ 0.001. This was driven by a higher fat intake at NICU B: mean (SD) 7.97 (±1.05) versus 6.20 (±0.92) g/kg/day, p ≤ 0.001, which in turn was explained by more liberal use of lipid supplements at NICU B. No significant differences were found in ΔSDS for weight, length or head circumference between the two NICUs. Despite considerable differences in energy intake due to the use of enteral lipid supplements, our study showed no differences in ΔSDS for weight, length or head circumference. This may be due to limited fat absorption in infants already receiving adequate energy and fat, and poor absorption of fat from human donor milk.