Objective To investigate the current status of breast milk management in neonatal intensive care units (NICUs) in Gansu Province and provide data support and a scientific basis for improvement. Methods Medical institutions at secondary level and above in prefectural and municipal areas of Gansu Province were targeted, and an online questionnaire on NICU breast milk management was administered to 107 hospitals. The questionnaire covered hospital support for breast milk management, screening of breast milk, quality control, and feeding-related health education and guidance. Results A total of 97 valid questionnaires were collected from hospitals across all prefecture-level cities in Gansu Province, with a valid response rate of 90.6%. Six hospitals had not admitted newborns in the past five years. Among the remaining 91 hospitals, 13 (14%) did not provide breastfeeding in the NICU, and 1 (1%) had a human milk bank. Among the 78 hospitals that provided breastfeeding, the utilization rate of milk preparation rooms was 89% in tertiary hospitals and 82% in secondary hospitals. The rate of establishing dedicated lactation rooms was low (19%). Tertiary hospitals used disposable feeding bottles more frequently than secondary hospitals (P<0.05), while secondary hospitals were more inclined to perform disinfection within the NICU (36%). Overall, 87% of hospitals had refrigerator temperature monitoring records, and 55% performed bacterial cultures of breast milk. Refrigerated storage was the primary method of breast milk preservation (89%). Breastfeeding education and guidance were mainly delivered through verbal education (97%). Conclusions Breast milk management in NICUs in Gansu Province remains suboptimal. Strengthening human milk bank construction to ensure supply and storage, establishing quality control systems to optimize management, enhancing staff training to standardize procedures, and reinforcing breastfeeding education to improve awareness are recommended.