* Abbreviations: HMBANA, : Human Milk Banks Association of North America MOM, : mother's own milk NEC, : necrotizing enterocolitis NICU, : neonatal intensive care unit PDHM, : pasteurized donor human milk 1. Pasteurized donor milk and exclusive human milk feeding are often interpreted interchangeably by clinicians, although the data in many studies are not homogenous. 2. Feeding practices and necrotizing enterocolitis rates differ greatly in trials on pasteurized donor milk compared with the national means in the United States and Canada. 3. Clinicians should balance pasteurized donor milk augmentation strategies with adequate monitoring to ensure targeted nutrition and that growth is achieved without displacing too much human milk. After completing this article, readers should be able to: 1. Describe the sources of pasteurized donor human milk (PDHM) in North America and be able to access the sites. 2. Outline the data that have been published on the role of PDHM in reducing the risk of confirmed necrotizing enterocolitis. 3. Prescribe a feeding strategy that uses PDHM as an augmentative practice in the neonatal intensive care unit. Human milk contains unique biologically active agents, such as growth factors, hormones, neuropeptides, and anti-inflammatory and immunomodulatory factors, that most likely are key features (1) that facilitate protection for the preterm infant from necrotizing enterocolitis (NEC) in the neonatal intensive care unit (NICU). (2) Mother’s own milk (MOM) is the preferred source, but if this is not sufficient or if the mother is unable to provide milk, the American Academy of Pediatrics has described pasteurized donor human milk (PDHM) as a safe alternative. (3) NICU feeding protocols, therefore, often include MOM and donor milk for at least the first 30 days after birth or until a corrected age of 34 weeks’ gestation or less, a period that appears to bear the highest risk of NEC. (4) However, on the basis of these studies, donor milk may not be a panacea because the incidence of NEC in the control groups of the 2 most frequently cited recent trials is very high (15.9% …