A Systematic Review on the Impact of Donor Characteristics and Donor Milk Handling on Infant Health and Growth

: Global recommendations advocate the conditional use of donor human milk (DHM), yet evidence on the influence of donor characteristics and DHM treatment on premature infants' health and growth is lacking. This study aimed to compare clinical outcomes of infants fed standard DHM compared with modified DHM-based on predefined variations. We performed a systematic review searching 14 databases alongside clinical trial registries, up to 8 March, 2024. Any study designs, but case or animal studies, conference proceedings, reviews, and gray literature were included. Findings were synthesized narratively and in tables. Of 14,979 screened studies, 14 met inclusion criteria comparing clinical effects of DHM from mothers who gave birth prematurely compared with at term, DHM that was treated with high-temperature pasteurization methods compared with standard holder pasteurization, and concentrated or homogenized DHM compared with standard DHM. Our analysis revealed a significant paucity of clinical data for several interventions and a complete lack of evidence for most of our research questions, indicating insufficient evidence to support the clinical use and efficacy of the aforementioned interventions. We found substantial evidence gaps in understanding how DHM treatments influence health and growth in premature infants. Research prioritizing clinical outcomes is essential to guide milk-banking policies. The protocol was registered on PROSPERO as CRD42024522015.