The American Academy of Pediatrics (AAP, 2017) released a new policy statement on pasteurized donor human milk (PDHM) emphasizing its importance for hospitalized infants. They highlighted the need to advance public policies to increase access to PDHM. However, AAP (2017) noted use of PDHM is currently limited by its affordability and availability.

The Human Milk Banking Association of North America (HMBANA) is the governing body for nonprofit milk banks. Human Milk Banking Association of North America milk banks charge approximately $4.00 to $5.00 per ounce for PDHM, which is a processing fee that covers costs involved with screening the mother, laboratory testing of the mother's blood and milk, processing of the milk, supplies, shipping costs, and general overhead of running a nonprofit milk bank.

When considering the cost argument that PDHM is too expensive and thus its use must be restricted or limited, one must consider how cost of PDHM compares with other interventions routinely used in care of critically ill neonates. Using a cost of $4.50 per ounce and providing a critically ill infant trophic feeds at a rate of 5 mL every 3 hours, or 40 mL per day, the cost for 1 day of PDHM would only be $6.00 per day. The cost of total parenteral nutrition (TPN) is over $1,000 per day. Healthcare professionals who work in neonatal intensive care units (NICU) would argue that TPN is essential intervention to provide care for critically ill neonates. Why is PDHM not held in the same regard as TPN-an essential intervention? Pasteurized donor human milk is a low-cost intervention compared with many other interventions in the NICU setting (Edwards & Spatz, 2012).

In terms of availability of PDHM, HMBANA has more than doubled its distribution in the past 5 years (HMBANA, 2017). In 2016 alone, HMBANA distributed 5.25 million ounces of PDHM (HMBANA). The number of HMBANA milk banks has more than tripled in the last decade, so a robust, safe, and reliable supply of PDHM is readily available to meet user demands (HMBANA).

Although it is not realistic that all hospitals will become their own milk bank, every hospital could develop a working relationship with a HMBANA milk bank in their region for both ordering PDHM and facilitating the screening of mothers for milk donation. Hospitals should have information on PDHM readily available for both healthcare professionals and for families. As healthcare professionals, we need to value PDHM not as a replacement to mom's own milk but as a bridge to mom's own milk as she is establishing her milk supply. In addition, there may be mothers who are unable to achieve a full milk supply despite a diligent pumping regime (e.g., glandular hypoplasia or breast reduction surgery). Pasteurized donor human milk needs to be considered as an essential and integral intervention in the care of neonates. The value of human milk has been well established to decrease morbidity and mortality of infants; therefore, the use of PDHM should be viewed as a necessary bridge to help improve the exclusivity of human milk feeding particularly for NICU and other vulnerable infants.

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