Is Frozen Human Milk That Is Refused by Mother's Own Infant Suitable for Human Milk Bank Donation?

Background: Infant refusal to feed previously frozen human milk is thought possibly attributable to lipase, an enzyme that cleaves fatty acids from milk triglycerides potentially changing the taste of the milk. Previous reports suggest that this milk is not harmful to infants; however, the lipase activity, macronutrient content, concentration of free fatty acids (FFAs), pH, and bacterial load of milk that meets this criterion are not fully understood. Objective: The objective was to determine whether refused frozen milk is different in composition from typical milk deposits received at a human milk bank. Methods: Frozen milk deposits previously refused by mother's own infant were collected from 16 mothers at five different time points when available (postpartum days 30, 60, 90, 120, and 150). Lipase activity, macronutrient composition, levels of FFA, pH, and bacteriology were determined. Analysis of mature donor milk and bacteriology data from the Ontario milk bank were used as controls. Results: The lipase activity for all samples was at or below literature values for mature human milk and lower compared with control milk (p < 0.001) for all time periods except at day 30. Macronutrient composition was not different from control values and did not change significantly over 150 days, with the exception of crude protein, which declined with milk maturity (p < 0.005). The pH for all postpartum time groups was lower (p < 0.02) in refused milk, and was inversely associated with lipase activity and FFA. FFA and bacterial counts were not different from control samples. Conclusions: Infant refusal of previously frozen milk may not be entirely due to endogenous lipase activity. This milk appears suitable for donation to human milk banks.