Recommendations for research

We have made the following recommendations for research, based on our review of evidence, to improve NICE guidance in the future.

Although it was not part of the scope of this guideline, it is known that there is limited high-quality evidence on the benefits of donor breast milk. The aim of this guideline is to provide guidance on the operation of donor milk banks; however, our expectation is that, once any risks of donor milk banking are minimised, further research can be undertaken to evaluate the benefits of donor milk, and to identify the recipient babies who would benefit most.

The research recommendations below relate to the process of donor milk banking. Where appropriate, they also recommend evaluating outcomes in the recipient population.

1 The process of handling donor milk

What is the effect of the process of milk banking on the nutritional and immunological components of donor milk?

Why this is important

The handling of donor milk includes a range of processes – including transport, storage and heat treatment – and is known to affect various biological, nutritional and immunological properties of breast milk. In addition, new methods of processing, such as heat or pressure treatment, are now being used in the food industry. However, there is very little comparative evidence on the different effects of the processes and how changes in the detailed process (for example, a change in temperature of 1°C) may affect the biological, nutritional and immunological properties of the milk. There is also no direct evidence of how these changes affect outcomes for recipients.

Further research is needed on the comparative effects of all milk handling processes on nutritional and immunological components, and, where possible, the impact of these on health outcomes for the recipients and on resource use during milk banking and following supply to recipients.

2 Nutritional assessment of donor milk

How and when should the nutritional components of donor breast milk be assessed?

Why this is important

It is known that the process of donor milk banking (for example, storage and heat treatment) affects the nutritional composition of milk. It is not clear how such changes affect health outcomes for recipients. Currently, in the UK, nutritional assessment of donor breast milk is not common practice.

Further research is needed to define clinically important changes and to determine the most useful methods and timing of measuring these in UK milk banking practice.

3 Milk donors

What are the attitudes and behaviours (including lifestyle factors such as diet) of milk donors, and can they affect the quality of donor milk?

Why this is important

There is very limited evidence on the attitudes and behaviours of milk donors, including the reason why they choose to donate. There is no evidence on how these factors (for example, ongoing donation or a one-off donation or dietary behaviours) may be associated with the quality of donated milk.

Further research is needed to understand the link between donor attitudes or behaviours and the quality of milk.