The development of a human milk fortifier formulated by concentrating pasteurized donor human milk and then adding vitamins and minerals has created the possibility of providing an “all-human diet” to premature infants. Various caloric densities of this fortifier allow for individual adjustment based on growth or blood urea nitrogen. A small study demonstrated a decrease in both moderate and severe NEC in small premature infants (birth weight < 1250 g) receiving the “all-human diet.” Unfortunately this study was not adequately powered to study NEC as an outcome and the comparison group received formula if mother’s milk supply was not adequate whereas the “all-human” infants received donor human milk in such a situation (i.e the increase in NEC in the comparison group could be related to either the powdered bovine human milk fortifier or the premature infant formula). This study underscores the fundamental question of whether components of human milk are protective against NEC or components of bovine milk somehow induce NEC. These two possibilities are, of course, not mutually exclusive. The cost of providing a fortifier made from donor human milk is significant. A recent cost-benefit analysis suggested that the savings in NEC prevention outweigh the costs of the “all-human” strategy, however this analysis was based on assumptions generated from the clinical trial described above and may therefore overestimate the protective effect of this approach.The ethical issues of marketing human milk for profit have recently been reviewed.