title: Optimal Distribution and Utilization of Donated Human Breast Milk.
abstract: BACKGROUND
  The nutritional content of donated expressed breast milk (DEBM) is variable. Using DEBM to provide for the energy requirements of neonates is challenging.
  
  
  OBJECTIVE
  The authors hypothesized that a system of DEBM energy content categorization and distribution would improve energy intake from DEBM.
  
  
  METHODS
  We compared infants' actual cumulative energy intake with projected energy intake, had they been fed using our proposed system. Eighty-five milk samples were ranked by energy content. The bottom, middle, and top tertiles were classified as red, amber, and green energy content categories, respectively. Data on 378 feeding days from 20 babies who received this milk were analyzed. Total daily intake of DEBM was calculated in mL/kg/day and similarly ranked. Infants received red energy content milk, with DEBM intake in the bottom daily volume intake tertile; amber energy content milk, with intake in the middle daily volume intake tertile; and green energy content milk when intake reached the top daily volume intake tertile.
  
  
  RESULTS
  Actual median cumulative energy intake from DEBM was 1612 (range, 15-11 182) kcal. Using DEBM with the minimum energy content from the 3 DEBM energy content categories, median projected cumulative intake was 1670 (range 13-11 077) kcal, which was not statistically significant ( P = .418). Statistical significance was achieved using DEBM with the median and maximum energy content from each energy content category, giving median projected cumulative intakes of 1859 kcal ( P = .0006) and 2280 kcal ( P = .0001), respectively.
  
  
  CONCLUSIONS
  Cumulative energy intake from DEBM can be improved by categorizing and distributing milk according to energy content.
authors.affiliation: 1 Neonatal Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, UK.|2 NHS Greater Glasgow & Clyde Donor Breast Milk Bank, Southern General Hospital, Glasgow, UK.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Simpson
authors.affiliation: 1 Neonatal Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: McKerracher
authors.affiliation: 3 Neonatal Intensive Care Unit, Southern General Hospital, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cooper
authors.affiliation: 2 NHS Greater Glasgow & Clyde Donor Breast Milk Bank, Southern General Hospital, Glasgow, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Barnett
authors.affiliation: 1 Neonatal Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Gentles
authors.affiliation: 1 Neonatal Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Cairns
authors.affiliation: 4 School of Medicine, University of Glasgow, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gerasimidis
mesh_terms: D001942:Breast Feeding / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods*; D002149:Energy Intake / Q000502:physiology; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000706:statistics & numerical data* / Q000600:supply & distribution; D007231:Infant, Newborn; D008895:Milk, Human; D009751:Nutritional Requirements / Q000502:physiology; D009753:Nutritive Value / Q000502:physiology
keywords: breast milk expression; breastfeeding; intensive care units; milk banks; neonatal; nutrition