Project Title: Donor Human Milk Versus Preterm Formula as a Substitute for Mothers' Own Milk for Feeding Very Low Birth Weight Infants

Short Title: DoMINO

Principal Investigators: Deborah O'Connor PhD RD, Sharon Unger MD FRCPC,

Sharyn Gibbins NP PhD

Co-Investigators: Elizabeth Asztalos MD MSc FRCPC, Alexander Kiss PhD, Joanne Rovet PhD, 

Carol Westall PhD

Funding Source: Canadian Institutes of Health Research (CIHR) 2010-2015

Health authorities recommend mother's milk as the sole source of nutrition for infants for the first six months of life. Mother's milk is associated with improved cognitive development, decreased mortality and decreased morbidity. Importantly for VLBW infants who are at elevated risk of neurologic sequelae, mother's milk enhances their neurocognitive development.  Further, mother's milk reduces the risk of necrotizing enterocolitis and sepsis; improves language, motor and visual development; and improves feeding tolerance. 

However, mothers of many VLBW infants are unabe to provide an adequate supply of milk; therefore, supplementation with formula is the current standard of care.  In response to evidence supporting the benefits of mother's milk in the VLBW population, donor human milk banks are being set up internationally at an unprecedented rate.  Despite pressure to similarly open milk banks in Canada, there is insufficient data to judge whether donor milk will result in better neurodevelopment, support adequate growth and reduce morbidity compared to preterm formula as a supplement to mother's milk.


As mother's milk has been shown to improve neurodevelopment and reduce morbidity, it is essential to ascertain whether donor milk will confer the same advantage over preterm formula without undue risks and at an acceptable cost.  Knowledge translation from this trial will be pivotal in setting public policy for the establishment of milk banks in Canada and beyond as well as in the development of feeding policies for VLBW infants.