Neonatologists know the pattern well: A preterm infant is growing steadily on mother’s own milk (MOM). Then supply dips, or a mother is recovering from a complicated delivery, or lactation is just not an option. The infant transitions to donor human milk (DHM). Growth slows because donor milk is produced for the donor’s baby, not for a 23‑weeker in intensive care. But donor variability is only the first layer of the problem.
Clinicians adjust fortification, increase calories, change the recipe, recheck labs, and adjust again. The result is fortification orders that remain in flux until the infant’s growth trajectory stabilizes. For premature infants, this flux is often a recurring state.
The problem isn’t just that donor milk isn’t intended for preterm or low birthweight infants. The problem is also what happens to human milk once it enters the donor milk supply chain.
Once DHM enters the donor supply chain, every step—pooling, freezing, thawing, heating, transferring—changes the milk’s composition.
Mother’s own milk (MOM) is the clinical gold standard for preterm growth. In its original state, it is biologically active, structurally intact, and naturally calibrated to the infant’s developmental stage. Mothers of preterm infants produce milk with higher concentrations of protein, sodium, and bioactive components than term milk, supporting gut maturation and immune protection. Its fat globules are intact, optimizing fat absorption and caloric delivery. The native quaternary structure of its proteins is preserved, allowing lactoferrin, IgA, and lysozyme to perform their critical biological roles.
Even so, preterm MOM alone does not meet the full nutritional demands of VLBW infants, and fortification is standard of care to close the gaps in protein, calcium, and calories.
Processing reduces nutritional value
When donor human milk is processed, each transfer step causes small but cumulative nutrient losses, particularly fat separation and protein unfolding, even before pasteurization occurs.
Holder and VAT pasteurization are effective at inactivating vegetative bacteria and many viruses. But they do not pasteurize at temperatures high enough to reliably inactivate heat-resistant spore-formers like Bacillus cereus, and come with a cost of an average of 30% degradation of proteins and immune factors.
Holder and VAT use heat at 145 degree Fahrenheit for 30 minutes. This extended exposure to heat unravels proteins. The longer a protein’s exposure to heat, the more severe the effects. The quaternary structure that allows lactoferrin to bind iron or IgA to bind pathogens collapses when exposed to prolonged heat. Holder and VAT pasteurization keep milk at elevated temperatures long enough to denature these proteins, leaving them structurally intact enough to measure but functionally less effective at their biological roles.
Protein is the foundation of growth in preterm infants. Lean body mass accretion, organ development, enzymatic and hormonal pathways, and immune maturation all depend on intact functional proteins.
However the functional protein available to the infant may be significantly lower than expected. For VLBW infants, protein is the limiting substrate for growth. Calories alone cannot build tissue; only amino acids can. When protein intake falls short, or when proteins lose their biological function due to heat, infant growth velocity declines. This is why even small protein deficits show up quickly on the growth curve. It is also why neonatologists adjust fortification when growth slows: they are trying to compensate for the loss of functional protein in donor milk.
But fortification can only add so much. If the underlying protein structure is compromised, the infant is starting from a deficit.
The conundrum is that donor human milk must be processed to make it safe for fragile babies with underdeveloped immune systems, but traditional pasteurization heats the milk for too long, compromising its proteins.
A Different Approach: Gentle-UHT™
LactaLogics’ Gentle‑UHT™ was designed to achieve bacterial safety without sacrificing the proteins and other components that drive growth.
Instead of a direct collision between steam and milk, Gentle‑UHT™ uses indirect heat.
The breakthrough behind Gentle‑UHT™ is the control of ultra-high heat transfer that reduces pasteurization time to under six seconds. By placing 285 degree Fahrenheit steam in an outer tube and milk in an inner tube, with the fluids flowing in opposite directions, heat is transferred efficiently and gently. The milk reaches temperatures high enough to inactivate pathogens, including heat‑resistant organisms like B. cereus. The increased heat kills B. cereus and the reduced pasteurization time preserves proteins.
The result is donor human milk that is bacterially safe and protein rich. Initial analysis shows retention of over 90% of the protein functionality found in raw milk. It is the first processing method to meaningfully close the gap between MOM and DHM in terms of protein integrity.
For clinicians, the implications are significant. More intact protein means fewer fortification adjustments and more predictable growth trajectories. For NICU dietitians, it means a more stable nutritional base, enabling more precise fortification. For milk rooms, shelf stability reduces waste and simplifies workflows. And for families, it means the milk going into their baby is closer to what nature intended—with intact protein, biologically active, and designed to support growth during the most critical weeks of life.