Donor human milk, a cornerstone of nutritional support for preterm infants whose mothers cannot provide enough breast milk, has long been recognized for its immunologic and digestive benefits. Supplementing or replacing formula with donor milk reduces risks linked to formula feeding, such as infections and impaired gut development. However, until now, the importance of milk freshness—specifically how long it is stored frozen before being fed—has not been thoroughly investigated. This study fills that critical knowledge gap by examining whether the age of frozen donor milk affects its protective bioactivity and clinical outcomes in preterm infants.

Dr. Katherine E. Chetta, a neonatologist and physician-scientist at MUSC, spearheaded this investigation. Her dual expertise in neonatal medicine and breast milk science enabled a meticulous clinical and laboratory evaluation of stored donor milk’s efficacy. The research leveraged a retrospective case-control design reviewing clinical data from 262 very low birth weight infants admitted to the MUSC Shawn Jenkins Children’s Hospital NICU between February 2022 and January 2024. These infants, all weighing less than approximately 3.3 pounds at birth, were exclusively or predominantly fed donor milk, allowing for a focused assessment of storage duration effects on gastrointestinal morbidity, including NEC.

The results were striking: with every additional day of storage, the odds of developing NEC or spontaneous intestinal perforation rose by 3.7%. These findings challenge established guidelines by the World Health Organization and Centers for Disease Control and Prevention, which currently allow frozen donor milk storage of up to one year. According to Dr. Chetta, the optimal ‘freshness window’ for donor milk to confer maximum gut protection in fragile preemies is approximately 240 days or shorter. This threshold demarcates a critical time after which detrimental biochemical changes in breast milk components begin to undermine its protective qualities.

Biochemical analyses conducted alongside clinical observations revealed a progressive degradation of key milk constituents during frozen storage. These include immune-modulating proteins, growth factors, and enzymes essential to mucosal integrity and anti-inflammatory defense in the immature preterm gut. The cumulative loss of these components compromises the milk’s ability to mitigate inflammatory processes implicated in NEC pathogenesis. Thus, the sheer duration of storage acts as a variable modulating the efficacy of donor milk as a living therapy rather than just a nutritional substitute.

Clinically, these findings hold profound implications. NEC remains a major cause of morbidity and mortality in NICUs worldwide, with limited proven prevention strategies. The identification of milk storage duration as a modifiable risk factor introduces a practical and immediate avenue for intervention. Dr. Chetta’s team has already implemented procedural adjustments in their NICU, prioritizing the use of fresher donor milk for the smallest and sickest infants. These changes reflect a paradigm shift, emphasizing temporal quality control in milk banking logistics, from donor recruitment to milk processing and storage practices.

Moreover, this research underscores the importance of interdisciplinary collaboration between neonatologists, dietitians, milk banks, and clinical researchers to optimize milk handling. By reducing transport times from collection sites to the hospital milk room and revising stock rotation protocols, NICUs can enhance the availability of fresher milk without increasing waste. The study highlights a scalable system intervention whereby milk banks and neonatal units establish tighter integration to preserve the bioactivity of donor milk, ultimately improving neonatal outcomes.

Impressively, this study combined rigorous clinical data analysis with laboratory science, bridging translational gaps that too often hinder pediatric nutrition innovations. It utilized the expertise of the South Carolina Clinical & Translational Research Institute to provide robust statistical validation, ensuring the findings were not merely correlative but support prioritizing milk freshness as a determinant of gastrointestinal health in preterm infants. This level of rigor is a model for future investigations into other nutritional therapies affecting neonatal morbidity.

While the study offers compelling evidence for revising milk storage guidelines, Dr. Chetta emphasizes that it does not advocate discarding older milk unnecessarily; rather, it calls for strategic prioritization and efficient use of fresher milk in those at greatest risk. This nuanced approach balances resource stewardship with patient safety, ensuring sustainable applications of this new evidence across diverse healthcare settings. It invites further research to refine optimal storage durations for different subpopulations and to explore technological innovations in milk preservation.

The wider implications of this study extend beyond NICU walls. It prompts reexamination of nutritional best practices in all contexts where frozen human milk is used, especially for medically fragile infants with compromised immune systems or underdeveloped digestive tracts. It also highlights the intrinsic complexity of breast milk as a bioactive fluid, whose therapeutic properties are sensitive to handling and storage conditions, reinforcing the importance of maintaining its integrity throughout the continuum of care.

In summary, MUSC’s pioneering research advocates for a paradigm shift in neonatal nutrition strategy: prioritizing fresher donor human milk to minimize devastating gastrointestinal complications in preterm infants. This revelation carries the promise of improved survival, reduced long-term sequelae, and enhanced quality of life for preemies globally. As neonatal care continues to evolve, integrating these findings into practice guidelines could rapidly transform standards, making fresh human milk not just a nutritional choice but a vital, time-sensitive clinical intervention.

The Medical University of South Carolina continues to lead forefront research in neonatal science, aiming to safeguard the youngest and most vulnerable patients. With this study, they chart a course toward safer, more effective nutrition that honors the biological complexity of breast milk and the delicate needs of preterm infants. Clinicians, researchers, and milk banks worldwide will be watching closely as these findings herald a new chapter in the life-saving potential of donor human milk.

Subject of Research: People
Article Title: Donor human milk storage and gastrointestinal morbidities in preterm infants: A case‐control study
News Publication Date: 1-Aug-2025
Web References: http://dx.doi.org/10.1002/jpen.2780
Image Credits: Medical University of South Carolina. Photograph by Julie Taylor.
Keywords: donor human milk, necrotizing enterocolitis, preterm infants, milk storage duration, neonatal nutrition, gastrointestinal morbidity, breast milk bioactivity, milk banking, neonatal intensive care unit, frozen milk storage, infant gut health, neonatal research

For decades, research in neonatal care has predominantly concentrated on parents’ mental health, coping strategies, and satisfaction with hospital services. While immensely valuable, this literature has inadequately addressed how frontline providers—nurses, physicians, and social workers—perceive and interpret the complexities of family experiences. The study authored by Belkin, Lerou, Vranceanu, and colleagues fills this gap by exploring the lived experiences of families through the eyes of NICU staff, providing a lens that accounts for relational dynamics and systemic interdependencies within the clinical setting.

The researchers deployed qualitative methodologies, including in-depth interviews and observational analyses, to gather rich, narrative data from multidisciplinary teams across various NICUs. These narratives illuminate how care providers conceptualize “family” not merely as biological units but as dynamic systems shaped by emotional, social, and psychological factors interacting within the hospital milieu. Such an approach underscores the importance of seeing each family’s story as unique, embedded within broader social contexts and healthcare structures.

Central to the findings is the recognition that NICU staff perceive family experiences as multi-layered and evolving. They report that families oscillate between hope, fear, resilience, and grief, often simultaneously, which profoundly influences how staff tailor their communication and support strategies. This awareness challenges the oversimplified dichotomy of “successful” versus “distressed” families often portrayed in previous literature, highlighting the fluidity and complexity of familial adaptation during neonatal critical care.

Moreover, the study details how NICU providers describe their roles not just as medical experts but as emotional anchors and facilitators of family cohesion. For instance, nurses recount moments when their interventions extend beyond clinical protocols to include comforting parents during devastating prognoses or mediating tensions in family interactions. This relational caregiving model underscores a systemic interdependence whereby staff well-being and family experiences are mutually responsive.

From a systemic standpoint, the research also identifies institutional factors influencing how staff perceive and engage with families. Staffing ratios, time constraints, physical environment, and organizational culture all modulate the quality and depth of relational connections. Some providers express frustration when systemic limitations hinder their ability to respond adequately to families’ psycho-social needs, pointing to a need for structural reforms that support holistic NICU care.

Importantly, the investigation sheds light on the emotional toll that witnessing family suffering exacts on staff themselves. Providers frequently describe experiences of vicarious trauma and professional burnout, which complicate their capacity to be fully present and responsive. Addressing this reciprocal dynamic becomes critical, suggesting interventions that promote resilience and reflective practice among NICU teams as essential complements to family-centered care innovations.

The integration of relational and systemic analysis into NICU care offers potential pathways for enhancing clinical training and policy development. By equipping staff with tools to interpret family distress within broader social frameworks, interventions can become more empathetic and tailored, thereby improving both family satisfaction and health outcomes. This holistic perspective encourages a departure from fragmented approaches toward truly integrated care models.

Furthermore, the study’s implications extend to the design of NICU spaces and workflows. Recognizing the importance of relational encounters calls for environmental adaptations that facilitate comfortable, private, and calming settings for families and providers alike. Such trauma-informed design principles can play a pivotal role in mitigating stress responses and fostering positive relational dynamics.

This new research crystallizes the critical insight that the NICU experience is profoundly relational and contextual. Families do not navigate neonatal crises in isolation; their stories interweave with the values, emotions, and capacities of the staff who support them. Efforts to improve neonatal care must therefore cultivate these reciprocal relationships, ensuring that staff perspectives are not overshadowed but integrated into holistic models of family-centered NICU practice.

As hospital systems move toward greater recognition of psychosocial dimensions in medical care, studies like this provide an evidentiary basis for transformative policies. Embedding staff perspectives into design, training, and support structures acknowledges their indispensable role in shaping family experiences. It also highlights the need for resources that sustain the emotional health of providers, thereby sustaining quality care delivery.

In sum, the investigation into NICU staff perceptions broadens our understanding of what it means to support families in one of the most vulnerable phases of life. It calls for a paradigm shift whereby neonatal care transcends clinical metrics to embrace the relational stories that each family brings. By doing so, the NICU can evolve into a space not only of advanced medical intervention but also of empathetic partnership and systemic synergy.

This emergent perspective aligns with contemporary movements in healthcare emphasizing biopsychosocial models and patient- and family-centered care. It prompts clinicians, administrators, and policymakers to rethink how care environments and professional roles are structured around the interconnectedness of human experience. Ultimately, such reflection promises not only to enhance NICU family well-being but also to enrich the professional fulfillment and sustainability of NICU staff.

With the publication of this study, the neonatal care community is invited to reconsider entrenched paradigms and embrace complexity in its many forms. “Each family has a story,” as the authors poignantly conclude, and understanding these stories from the relational vantage point of staff provides a more comprehensive, humane framework that can inform future research, education, and practice in perinatal medicine.

Subject of Research:
Exploration of Neonatal Intensive Care Unit (NICU) staff perceptions regarding family experiences, emphasizing relational and systemic perspectives.

Article Title:
“Each family has a story:” lived experiences of NICU families from staff perspectives.

Article References:
Belkin, E.M., Lerou, P.H., Vranceanu, A.M., et al. “Each family has a story:” lived experiences of NICU families from staff perspectives. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02435-6

DOI:
https://doi.org/10.1038/s41372-025-02435-6

Image Credits: AI Generated