{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:29:16Z","timestamp":1786361356897,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Donor human milk (DHM) is recommended when the mother\u2019s own milk (MOM) is unavailable for extremely low birth weight (ELBW) infants. However, the impact of DHM implementation on NICUs with already high human milk utilization remains incompletely characterized. Objective: We aimed to evaluate the association between DHM implementation and feeding practices, feeding progression, parenteral nutrition (PN) exposure, and major neonatal morbidities in ELBW infants. Methods: We conducted a retrospective before\u2013after cohort study in a single tertiary NICU including 116 ELBW infants with feeding data through day 28 (58 pre-DHM; 58 post-DHM). Exploratory multivariable models evaluated factors associated with NEC and PN duration. Results: In the post-DHM epoch, enteral feeding was initiated earlier (2 vs. 2.5 days, p &lt; 0.001) and full enteral feeding was achieved sooner (14 vs. 24.5 days, p &lt; 0.001). PN duration was numerically shorter (17.5 vs. 27 days, p = 0.088). Feeding shifted from predominantly exclusive MOM to mixed MOM + DHM regimens, eliminating formula-only feeding. NEC, feeding intolerance, bloodstream infection, and mortality did not differ between epochs. Feeding intolerance was associated with NEC, whereas lower gestational age predicted longer PN duration; epoch was not independently associated with either outcome. Conclusions: In this high-MOM NICU, DHM implementation was associated mainly with earlier feeding progression and reduced formula reliance, without a measurable reduction in NEC.<\/jats:p>","DOI":"10.3390\/nu18162608","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:23:50Z","timestamp":1786357430000},"page":"2608","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Donor Human Milk Implementation in a High-Mother\u2019s-Own-Milk NICU: Impact on Feeding Progression and Clinical Outcomes in Extremely Low Birth Weight Infants"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8999-6841","authenticated-orcid":false,"given":"Jacky","family":"Herzlich","sequence":"first","affiliation":[{"name":"Department of Neonatology, Dana Dwek Children\u2019s Hospital, Tel Aviv Sourasky University Medical Center, Tel Aviv 6423906, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2395-1652","authenticated-orcid":false,"given":"Omer","family":"Less","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1186-045X","authenticated-orcid":false,"given":"Bar","family":"Frumer","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4019-7146","authenticated-orcid":false,"given":"Ronella","family":"Marom","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Dana Dwek Children\u2019s Hospital, Tel Aviv Sourasky University Medical Center, Tel Aviv 6423906, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6750-2270","authenticated-orcid":false,"given":"Laurence","family":"Mangel","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Dana Dwek Children\u2019s Hospital, Tel Aviv Sourasky University Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1284-0990","authenticated-orcid":false,"given":"Dror","family":"Mandel","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Dana Dwek Children\u2019s Hospital, Tel Aviv Sourasky University Medical Center, Tel Aviv 6423906, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993\u20132012","volume":"314","author":"Stoll","year":"2015","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1542\/peds.2009-2959","article-title":"Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network","volume":"126","author":"Stoll","year":"2010","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147.e1","DOI":"10.1016\/j.ajog.2006.09.014","article-title":"Trends in neonatal morbidity and mortality for very low birthweight infants","volume":"196","author":"Fanaroff","year":"2007","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Alsaied, A., Islam, N., and Thalib, L. (2020). Global incidence of Necrotizing Enterocolitis: A systematic review and Meta-analysis. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02231-5"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1159\/000358474","article-title":"Necrotizing enterocolitis","volume":"110","author":"Neu","year":"2014","journal-title":"World Rev. Nutr. Diet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"562594","DOI":"10.5402\/2012\/562594","article-title":"Necrotizing enterocolitis in very low birth weight infants: A systemic review","volume":"2012","author":"Patel","year":"2012","journal-title":"ISRN Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1111\/apa.16836","article-title":"Surgical management of necrotising enterocolitis in Sweden: A national cohort study","volume":"112","author":"Svenningsson","year":"2023","journal-title":"Acta Paediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1053\/j.semperi.2016.09.020","article-title":"Surgical necrotizing enterocolitis","volume":"41","author":"Robinson","year":"2017","journal-title":"Semin. Perinatol."},{"key":"ref_9","first-page":"CD002971","article-title":"Donor human milk for preventing necrotising enterocolitis in very preterm or very low-birthweight infants","volume":"9","author":"Quigley","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.jpeds.2009.10.040","article-title":"An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products","volume":"156","author":"Sullivan","year":"2010","journal-title":"J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Altobelli, E., Angeletti, P.M., Verrotti, A., and Petrocelli, R. (2020). The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis. Nutrients, 12.","DOI":"10.3390\/nu12051322"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1089\/bfm.2013.0121","article-title":"An exclusively human milk diet reduces necrotizing enterocolitis","volume":"9","author":"Herrmann","year":"2014","journal-title":"Breastfeed. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Miller, J., Tonkin, E., Damarell, R.A., McPhee, A.J., Suganuma, M., Suganuma, H., Middleton, P.F., Makrides, M., and Collins, C.T. (2018). A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients, 10.","DOI":"10.3390\/nu10060707"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2022057988","DOI":"10.1542\/peds.2022-057988","article-title":"Section on Breastfeeding. Policy statement: Breastfeeding and the use of human milk","volume":"150","author":"Meek","year":"2022","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.clnu.2018.03.004","article-title":"Donor human milk and risk of surgical necrotizing enterocolitis: A meta-analysis","volume":"38","author":"Silano","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Carr, L.E., Virmani, M.D., Rosa, F., Munblit, D., Matazel, K.S., Elolimy, A.A., and Yeruva, L. (2021). Role of human milk bioactives on infants\u2019 gut and immune health. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.604080"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.pcl.2012.09.008","article-title":"Human milk for the premature infant","volume":"60","author":"Underwood","year":"2013","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1111\/apa.15534","article-title":"Maternal breastmilk, infant gut microbiome and the impact on preterm infant health","volume":"110","author":"Granger","year":"2021","journal-title":"Acta Paediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.jpeds.2012.07.013","article-title":"Cost of morbidities in very low birth weight infants","volume":"162","author":"Johnson","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Herzlich, J., Frumer, B., Mandel, D., Morag, S., Halperin, A., and Mangel, L. (2025). Effects of donor human milk and formula supplementation on bone me-tabolism and clinical outcomes in preterm infants receiving mother\u2019s own milk. Nutrients, 17.","DOI":"10.3390\/nu17203263"},{"key":"ref_21","first-page":"311","article-title":"Birth weight standards in the live-born population in Israel","volume":"7","author":"Dollberg","year":"2005","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.cnc.2023.09.002","article-title":"Mother\u2019s own milk versus donor human milk: What\u2019s the difference?","volume":"36","author":"Parker","year":"2024","journal-title":"Crit. Care Nurs. Clin. N. Am."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jpeds.2016.09.027","article-title":"Donor human milk update: Evidence, mechanisms, and priorities for research and practice","volume":"180","author":"Meier","year":"2017","journal-title":"J. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/jp.2011.176","article-title":"Hospital and neurodevelopmental outcomes of extremely low-birth-weight infants with necrotizing enterocolitis and spontaneous intestinal perforation","volume":"32","author":"Shah","year":"2012","journal-title":"J. Perinatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"F182","DOI":"10.1136\/archdischild-2017-313880","article-title":"Incidence of neonatal necrotising enterocolitis in high-income countries: A systematic review","volume":"103","author":"Battersby","year":"2018","journal-title":"Arch. Dis. Child.-Fetal Neonatal Ed."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1038\/s41372-025-02277-2","article-title":"The fifty billion dollar question: Does formula cause necrotizing enterocolitis?","volume":"45","author":"Underwood","year":"2025","journal-title":"J. Perinatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1177\/0890334416632203","article-title":"Use of donor human milk and maternal breastfeeding rates: A systematic review","volume":"32","author":"Williams","year":"2016","journal-title":"J. Hum. Lact."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1089\/bfm.2021.0155","article-title":"Pasteurized donor human milk should not replace mother\u2019s own milk in preterm neonates: A quality initiative toward decreasing the \u201cPDHM dependency\u201d","volume":"17","author":"Bagga","year":"2022","journal-title":"Breastfeed. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1111\/apa.14702","article-title":"Review shows that donor milk does not promote the growth and development of preterm infants as well as maternal milk","volume":"108","author":"Nilsson","year":"2019","journal-title":"Acta Paediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2622","DOI":"10.1016\/j.tjnut.2023.07.012","article-title":"Nutrient composition of donor human milk and comparisons to preterm human milk","volume":"153","author":"Gates","year":"2023","journal-title":"J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1093\/advances\/nmaa014","article-title":"The nutritional composition and energy content of donor human milk: A systematic review","volume":"11","author":"Perrin","year":"2020","journal-title":"Adv. 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