Mother’s own milk (MOM) is the optimal feed for all newborn babies, especially the sickest and most vulnerable. When insufficient MOM is available donated human milk (DHM) is recommended as an alternative [
1‐
3]. DHM differs from MOM for a variety of reasons, many of which relate to the handling and processing of the milk. The nutritional content of DHM varies greatly, with a mean difference in energy intake of 38.7 kcal/kg/day based on full enteral feeds of 180 ml/kg/day [
4,
5]. In addition, freezing, storage and heat treatment all impact on milk components and qualities. The Holder pasteurisation method (heating milk for 30 min at 62.5 ̊C) can reduce both fatty and amino acid content in DHM. For example, in one study the fatty acid content of DHM was 22% lower after pasteurisation [
6]. Another study found the mean difference of valine (an amino acid) content in pasteurised DHM was lower by 22 mmol compared to EBM from healthy women [
7]. Bioactive proteins such as immunoglobulins which are anti-inflammatory and important for immune modulation are lower in DHM than MOM because of pasteurisation [
8]. Despite these differences, DHM has been demonstrated to retain some of the benefits of MOM, in particular, a reduction in the incidence of necrotising enterocolitis (NEC). A recent Cochrane meta-analysis of nine clinical trials (1017 preterm infants) showed that, compared with formula feeding, DHM was significantly associated with a lower risk of NEC [
9,
10]. Given that approximately 50% of NEC cases require surgery or die [
11], and that survivors are at risk of sequelae including; prolonged dependence on parental nutrition, short bowel syndrome and impaired neurodevelopment [
12,
13], any intervention that reduces the risk of NEC is clinically and economically important. It is however well recognised that further research is required to inform practice and assist in prioritising DHM distribution [
14].
A frequently cited concern associated with DHM use is a potential negative impact on the provision of MOM. A recent systematic review provided reassurance that breastfeeding rates are not adversely affected by the use of DHM, however, it highlighted the limited evidence base from which it drew its conclusions [
15]. In particular, it is unclear whether using DHM as the first enteral feed will adversely influence subsequent MOM supply.
In the United Kingdom there are operational guidelines for milk banks but no national guidance on clinical indications for DHM usage [
16]. In the absence of evidence based, cost effective eligibility criteria, local guidelines are often used to inform practice. The primary aim of this work was to audit the use of DHM in our neonatal unit, comparing it to local guidance. The secondary aim was to explore the impact of using DHM as the first milk on subsequent feeding practice.