Why is human milk preferred for feeding high-risk neonates, and what strategies support optimal nutrition when maternal milk is unavailable?

• A. Reduces NEC and supports neurodevelopment; provide fortification and monitor growth; if donor milk or formula is used, ensure safe fortification.
• B. It provides higher iron content which prevents anemia in neonates.
• C. Human milk is not preferred; use formula to ensure exact caloric intake.
• D. Donor milk should always be avoided due to safety concerns.

Answer: (C)

Human milk provides immune factors, easier digestion, and bioactive components that support gut maturation and neurodevelopment, which together markedly reduce the risk of necrotizing enterocolitis in high-risk neonates. When maternal milk isn’t available, pasteurized donor human milk is the preferred alternative because it preserves many protective properties better than formula, helping safer growth and tolerance.

To support optimal nutrition, donor milk is usually fortified with human milk or protein fortifiers to meet the high caloric and protein needs of preterm or otherwise high-risk infants. The goal is typically about 110–135 kcal/kg/day with protein in the roughly 3.5–4 g/kg/day range, adjusting as needed based on growth and tolerance. If donor milk cannot meet these targets, safely chosen fortified preterm formula can be used while continuing to monitor growth, weight gain, and feeding tolerance.

Practical strategies include active lactation support to encourage expressed maternal milk, timely initiation and careful advancement of feeds, and regular monitoring of growth and metabolic tolerance. When using donor milk, rely on accredited milk banks with proper pasteurization and screening to ensure safety.