Treffer: Evaluating the Effect of Random Multi-Donor Pooling on the Nutritional Variability in Donor Human Milk Using Computer Modeling.
Title:
Evaluating the Effect of Random Multi-Donor Pooling on the Nutritional Variability in Donor Human Milk Using Computer Modeling.
Authors:
Smith RM; Department of Mathematics and Statistics, University of North Carolina Greensboro, Greensboro, North Carolina, USA., Richter S; Department of Mathematics and Statistics, University of North Carolina Greensboro, Greensboro, North Carolina, USA.; Department of Pediatrics, Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), and the Human Milk Institute (HMI), University of California, San Diego, La Jolla, California, USA., Iwayemi EF; Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA., Mansen K; Integrated Maternal and Child Health and Development, PATH, Seattle, Washington, USA., Israel-Ballard K; Integrated Maternal and Child Health and Development, PATH, Seattle, Washington, USA., Hampel D; Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA.; United States Department of Agriculture, Agriculture Research Service, Western Human Nutrition Research Center, Davis, California, USA., Shahab-Ferdows S; United States Department of Agriculture, Agriculture Research Service, Western Human Nutrition Research Center, Davis, California, USA., Allen LH; Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA.; United States Department of Agriculture, Agriculture Research Service, Western Human Nutrition Research Center, Davis, California, USA., Bode L; United States Department of Agriculture, Agriculture Research Service, Western Human Nutrition Research Center, Davis, California, USA., Perrin MT; Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA.
Source:
Maternal & child nutrition [Matern Child Nutr] 2026 Mar; Vol. 22 (1), pp. e70158.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101201025 Publication Model: Print Cited Medium: Internet ISSN: 1740-8709 (Electronic) Linking ISSN: 17408695 NLM ISO Abbreviation: Matern Child Nutr Subsets: MEDLINE
Imprint Name(s):
Publication: Oxford, UK : Wiley-Blackwell
Original Publication: Oxford, UK : Blackwell Pub., c2005-
Original Publication: Oxford, UK : Blackwell Pub., c2005-
MeSH Terms:
References:
Academy of Pediatrics Committee on Nutrition, Section on Breastfeeding, & Committee on Fetus and Newborn. 2016. Donor Human Milk for the High‐Risk Infant: Preparation, Safety, and Usage Options in the United States. Pediatrics.
Allen, L. H., M. M. Islam, G. Kac, et al., MILQ Study Consortium. 2025. “Reference Values for Minerals in Human Milk: The Mothers, Infants and Lactation Quality (MILQ) Study.” Supplement, Advances in Nutrition 16 Suppl 1, no. Suppl 1: 100431. https://doi.org/10.1016/j.advnut.2025.100431.
Allen, L. H., S. Shahab‐Ferdows, S. E. Moore, et al., MILQ Study Consortium. 2025. “Reference Values for B Vitamins in Human Milk: The Mothers, Infants and Lactation Quality (MILQ) Study.” Advances in Nutrition (Bethesda, Md.) 16, no. Suppl 1: 100500. https://doi.org/10.1016/j.advnut.2025.100500.
Amissah, E. A., J. Brown, and J. E. Harding. 2020. “Protein Supplementation of Human Milk for Promoting Growth in Preterm Infants.” Cochrane Database of Systematic Reviews 9, no. 9: CD000433. https://doi.org/10.1002/14651858.CD000433.pub3.
Autran, C. A., B. P. Kellman, J. H. Kim, et al. 2018. “Human Milk Oligosaccharide Composition Predicts Risk of Necrotising Enterocolitis in Preterm Infants.” Gut 67: 1064–1070. https://doi.org/10.1136/gutjnl-2016-312819.
Belfort, M. B., L. Stellwagen, K. North, S. Unger, D. L. O'Connor, and M. T. Perrin. 2024. “Deciphering Macronutrient Information about Human Milk.” Journal of Perinatology 44, no. 9: 1377–1381. https://doi.org/10.1038/s41372-024-02029-8.
Colaizy, T. T., B. B. Poindexter, and S. A. McDonald, et al.Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2024. “Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial.” Journal of the American Medical Association 331, no. 7: 582–591. https://doi.org/10.1001/jama.2023.27693.
Davis, A., S. Lee, D. Hampel, et al. (2025). The Impact of Holder Pasteurization on Macronutrients, Vitamins, Minerals and Bioactive Factors in Human Milk Processed in a Milk Bank Setting. Current Developments in Nutrition, online ahead of print.
Friend, L. L., and M. T. Perrin (2020). Fat and Protein Variability in Donor Human Milk and Associations With Milk Banking Processes. Breastfeeding Medicine.
Infant and Pediatric Feedings. Guidelines for Preparation of Human Milk and Formula in Health Care Facilities, 3rd Ed. (2019, January 31). https://www.eatrightstore.org/product-type/books/infant-and-pediatric-feedings.
John, A., R. Sun, L. Maillart, A. Schaefer, E. Hamilton Spence, and M. T. Perrin. 2019. “Macronutrient Variability in Human Milk From Donors to a Milk Bank: Implications for Feeding Preterm Infants.” PLoS One 14, no. 1: e0210610. https://doi.org/10.1371/journal.pone.0210610.
Lewis, J. I., D. K. Dror, D. Hampel, et al., MILQ Study Consortium. 2025. “Reference Values for Macronutrients in Human Milk: The Mothers, Infants and Lactation Quality (MILQ) Study.” Advances in Nutrition 16, no. Suppl 1: 100501. https://doi.org/10.1016/j.advnut.2025.100501.
Masi, A. C., N. D. Embleton, C. A. Lamb, et al. 2021. “Human Milk Oligosaccharide DSLNT and Gut Microbiome in Preterm Infants Predicts Necrotising Enterocolitis.” Gut 70, no. 12: 2273–2282. https://doi.org/10.1136/gutjnl-2020-322771.
Perrin, M. T., M. B. Belfort, J. I. Hagadorn, et al. 2020. “The Nutritional Composition and Energy Content of Donor Human Milk: A Systematic Review.” Advances in Nutrition 11, no. 14: 960–970.
Perrin, M. T., L. L. Friend, and P. M. Sisk. 2022. “Fortified Donor Human Milk Frequently Does Not Meet Sodium Recommendations for the Preterm Infant.” Journal of Pediatrics 244: 219–223.e1. https://doi.org/10.1016/j.jpeds.2022.01.029.
Perrin, M. T., K. Mansen, K. Israel‐Ballard, et al. 2025. “A Cross‐Sectional Study of Macronutrients, Vitamins, Minerals, and Bioactive Components in Human Milk of Approved Milk Bank Donors From Low‐, Middle‐, and High‐Income Countries.” American Journal of Clinical Nutrition 122, no. 5: 1317–1325. https://doi.org/10.1016/j.ajcnut.2025.07.031.
Perrin, M. T., K. Mansen, K. Israel‐Ballard, et al. 2023. “Investigating Donor Human Milk Composition Globally to Develop Effective Strategies for the Nutritional Care of Preterm Infants: Study Protocol.” PLoS One 18, no. 4: e0283846. https://doi.org/10.1371/journal.pone.0283846.
Quigley, M., N. D. Embleton, N. Meader, and W. McGuire. 2024. “Donor Human Milk for Preventing Necrotising Enterocolitis in Very Preterm or Very Low‐Birthweight Infants.” Cochrane Database of Systematic Reviews 9, no. 9: CD002971. https://doi.org/10.1002/14651858.CD002971.pub6.
R: The R Project for Statistical Computing. n.d. Retrieved December 16, 2024, from https://www.r-project.org/.
Tabasso, C., P. Piemontese, N. Pesenti, et al. 2023. “Pooling Strategies to Modify Macronutrient Content of Pasteurized Donor Human Milk.” Breastfeeding Medicine 18, no. 5: 370–376. https://doi.org/10.1089/bfm.2023.0043.
Walter, L., V. Clifford, C. Sulfaro, et al. 2023. “Macronutrient Content of Pasteurised Donor Human Milk: Variability Between Batches From Single‐Donor Pools at an Australian Milk Bank.” Journal of Paediatrics and Child Health 59, no. 12: 1281–1288. https://doi.org/10.1111/jpc.16497.
WHO Recommendations for Care of the Preterm or Low‐Birth‐Weight Infant. (2022). World Health Organization. https://www.who.int/publications-detail-redirect/9789240058262.
Wong, R. K., M. A. Pitino, R. Mahmood, et al. 2021. “Predicting Protein and Fat Content in Human Donor Milk Using Machine Learning.” Journal of Nutrition 151, no. 7: 2075–2083. https://doi.org/10.1093/jn/nxab069.
Young, B. E., L. L. Borman, R. Heinrich, et al. 2019. “Effect of Pooling Practices and Time Postpartum of Milk Donations on the Energy, Macronutrient, and Zinc Concentrations of Resultant Donor Human Milk Pools.” Journal of Pediatrics 214: 54–59. https://doi.org/10.1016/j.jpeds.2019.07.042.
Allen, L. H., M. M. Islam, G. Kac, et al., MILQ Study Consortium. 2025. “Reference Values for Minerals in Human Milk: The Mothers, Infants and Lactation Quality (MILQ) Study.” Supplement, Advances in Nutrition 16 Suppl 1, no. Suppl 1: 100431. https://doi.org/10.1016/j.advnut.2025.100431.
Allen, L. H., S. Shahab‐Ferdows, S. E. Moore, et al., MILQ Study Consortium. 2025. “Reference Values for B Vitamins in Human Milk: The Mothers, Infants and Lactation Quality (MILQ) Study.” Advances in Nutrition (Bethesda, Md.) 16, no. Suppl 1: 100500. https://doi.org/10.1016/j.advnut.2025.100500.
Amissah, E. A., J. Brown, and J. E. Harding. 2020. “Protein Supplementation of Human Milk for Promoting Growth in Preterm Infants.” Cochrane Database of Systematic Reviews 9, no. 9: CD000433. https://doi.org/10.1002/14651858.CD000433.pub3.
Autran, C. A., B. P. Kellman, J. H. Kim, et al. 2018. “Human Milk Oligosaccharide Composition Predicts Risk of Necrotising Enterocolitis in Preterm Infants.” Gut 67: 1064–1070. https://doi.org/10.1136/gutjnl-2016-312819.
Belfort, M. B., L. Stellwagen, K. North, S. Unger, D. L. O'Connor, and M. T. Perrin. 2024. “Deciphering Macronutrient Information about Human Milk.” Journal of Perinatology 44, no. 9: 1377–1381. https://doi.org/10.1038/s41372-024-02029-8.
Colaizy, T. T., B. B. Poindexter, and S. A. McDonald, et al.Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2024. “Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial.” Journal of the American Medical Association 331, no. 7: 582–591. https://doi.org/10.1001/jama.2023.27693.
Davis, A., S. Lee, D. Hampel, et al. (2025). The Impact of Holder Pasteurization on Macronutrients, Vitamins, Minerals and Bioactive Factors in Human Milk Processed in a Milk Bank Setting. Current Developments in Nutrition, online ahead of print.
Friend, L. L., and M. T. Perrin (2020). Fat and Protein Variability in Donor Human Milk and Associations With Milk Banking Processes. Breastfeeding Medicine.
Infant and Pediatric Feedings. Guidelines for Preparation of Human Milk and Formula in Health Care Facilities, 3rd Ed. (2019, January 31). https://www.eatrightstore.org/product-type/books/infant-and-pediatric-feedings.
John, A., R. Sun, L. Maillart, A. Schaefer, E. Hamilton Spence, and M. T. Perrin. 2019. “Macronutrient Variability in Human Milk From Donors to a Milk Bank: Implications for Feeding Preterm Infants.” PLoS One 14, no. 1: e0210610. https://doi.org/10.1371/journal.pone.0210610.
Lewis, J. I., D. K. Dror, D. Hampel, et al., MILQ Study Consortium. 2025. “Reference Values for Macronutrients in Human Milk: The Mothers, Infants and Lactation Quality (MILQ) Study.” Advances in Nutrition 16, no. Suppl 1: 100501. https://doi.org/10.1016/j.advnut.2025.100501.
Masi, A. C., N. D. Embleton, C. A. Lamb, et al. 2021. “Human Milk Oligosaccharide DSLNT and Gut Microbiome in Preterm Infants Predicts Necrotising Enterocolitis.” Gut 70, no. 12: 2273–2282. https://doi.org/10.1136/gutjnl-2020-322771.
Perrin, M. T., M. B. Belfort, J. I. Hagadorn, et al. 2020. “The Nutritional Composition and Energy Content of Donor Human Milk: A Systematic Review.” Advances in Nutrition 11, no. 14: 960–970.
Perrin, M. T., L. L. Friend, and P. M. Sisk. 2022. “Fortified Donor Human Milk Frequently Does Not Meet Sodium Recommendations for the Preterm Infant.” Journal of Pediatrics 244: 219–223.e1. https://doi.org/10.1016/j.jpeds.2022.01.029.
Perrin, M. T., K. Mansen, K. Israel‐Ballard, et al. 2025. “A Cross‐Sectional Study of Macronutrients, Vitamins, Minerals, and Bioactive Components in Human Milk of Approved Milk Bank Donors From Low‐, Middle‐, and High‐Income Countries.” American Journal of Clinical Nutrition 122, no. 5: 1317–1325. https://doi.org/10.1016/j.ajcnut.2025.07.031.
Perrin, M. T., K. Mansen, K. Israel‐Ballard, et al. 2023. “Investigating Donor Human Milk Composition Globally to Develop Effective Strategies for the Nutritional Care of Preterm Infants: Study Protocol.” PLoS One 18, no. 4: e0283846. https://doi.org/10.1371/journal.pone.0283846.
Quigley, M., N. D. Embleton, N. Meader, and W. McGuire. 2024. “Donor Human Milk for Preventing Necrotising Enterocolitis in Very Preterm or Very Low‐Birthweight Infants.” Cochrane Database of Systematic Reviews 9, no. 9: CD002971. https://doi.org/10.1002/14651858.CD002971.pub6.
R: The R Project for Statistical Computing. n.d. Retrieved December 16, 2024, from https://www.r-project.org/.
Tabasso, C., P. Piemontese, N. Pesenti, et al. 2023. “Pooling Strategies to Modify Macronutrient Content of Pasteurized Donor Human Milk.” Breastfeeding Medicine 18, no. 5: 370–376. https://doi.org/10.1089/bfm.2023.0043.
Walter, L., V. Clifford, C. Sulfaro, et al. 2023. “Macronutrient Content of Pasteurised Donor Human Milk: Variability Between Batches From Single‐Donor Pools at an Australian Milk Bank.” Journal of Paediatrics and Child Health 59, no. 12: 1281–1288. https://doi.org/10.1111/jpc.16497.
WHO Recommendations for Care of the Preterm or Low‐Birth‐Weight Infant. (2022). World Health Organization. https://www.who.int/publications-detail-redirect/9789240058262.
Wong, R. K., M. A. Pitino, R. Mahmood, et al. 2021. “Predicting Protein and Fat Content in Human Donor Milk Using Machine Learning.” Journal of Nutrition 151, no. 7: 2075–2083. https://doi.org/10.1093/jn/nxab069.
Young, B. E., L. L. Borman, R. Heinrich, et al. 2019. “Effect of Pooling Practices and Time Postpartum of Milk Donations on the Energy, Macronutrient, and Zinc Concentrations of Resultant Donor Human Milk Pools.” Journal of Pediatrics 214: 54–59. https://doi.org/10.1016/j.jpeds.2019.07.042.
Grant Information:
R01 HD106391 United States HD NICHD NIH HHS; R01HD106391 to MTP National Institute of Child Health and Human Development
Contributed Indexing:
Keywords: donor milk; milk banking; minerals; nutrition; preterm; vitamins
Substance Nomenclature:
0 (Nutrients)
0 (Vitamins)
0 (Milk Proteins)
0 (Minerals)
0 (Vitamins)
0 (Milk Proteins)
0 (Minerals)
Entry Date(s):
Date Created: 20260108 Date Completed: 20260108 Latest Revision: 20260127
Update Code:
20260130
PubMed Central ID:
PMC12780887
DOI:
10.1111/mcn.70158
PMID:
41503733
Database:
MEDLINE
Weitere Informationen
Protein and fat concentrations in donor human milk (DHM) can vary twofold to threefold and are influenced by the number of unique donors per pool. The aim of this study was to broadly characterize how the number of donors (2-10) randomly combined into a pool during milk bank processing influenced the variability of macronutrients, vitamins, minerals, and bioactive factors in DHM. The minimum number of donors required for 80% of the pools to meet pre-defined targets for true protein, fat, and disialyllacto-N-tetraose (DSLNT) was also evaluated. Monte Carlo simulation was used to create models that accounted for donor lifetime donation volume and milk bank production constraints. Variability in nutrients was quantified as a Nutrient Inequality Index (NII) which was computed as the ratio of the 90th percentile to the 10th percentile for each simulation. Random multi-donor pooling of 2-10 donors produced lower variability in DHM macronutrients than most vitamins and minerals. A priori targets of 0.9 g/dL of true protein, 3.5 g/dL of fat, and 210 µg/L of DSLNT could not be achieved with any random pooling scenario. The NII for lactose stabilized at less than 1.1 when there were 3+ donors per pool, while the NII for fat and true protein stabilized at less than 1.3 when there were 5+ donors per pool. The NII exceeded 1.5, even at 10 donors per pool, for several micronutrients including zinc, copper, sodium, iron, biotin, riboflavin, B6, B12, and pantothenic acid.
(© 2025 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)