Abstract
Objective: The aim of this study was to compare outcomes of infants pre and post initiation of a feeding protocol providing an exclusive human milk–based diet (HUM).Materials and Methods: In a multicenter retrospective cohort study, infants with a birth weight <1,250 g who received a bovine-based diet (BOV) of mother's own milk fortified with bovine fortifier and/or preterm formula were compared to infants who received a newly introduced HUM feeding protocol. Infants were excluded if they had major congenital anomalies or died in the first 12 hours of life. Data were collected 2–3 years prior to and after introduction of an exclusive HUM diet. Primary outcomes were necrotizing enterocolitis (NEC) and mortality. Secondary outcomes included late-onset sepsis, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD).Results: A total of 1,587 infants were included from four centers in Texas, Illinois, Florida, and California. There were no differences in baseline demographics or growth of infants. The HUM group had significantly lower incidence of proven NEC (16.7% versus 6.9%, p < 0.00001), mortality (17.2% versus 13.6%, p = 0.04), late-onset sepsis (30.3% versus 19.0%, p < 0.00001), ROP (9% versus 5.2%, p = 0.003), and BPD (56.3% versus 47.7%, p = 0.0015) compared with the BOV group.Conclusions: Extremely premature infants who received an exclusive HUM diet had a significantly lower incidence of NEC and mortality. The HUM group also had a reduction in late-onset sepsis, BPD, and ROP. This multicenter study further emphasizes the many benefits of an exclusive HUM diet, and demonstrates multiple improved outcomes after implementation of such a feeding protocol.
Highlights
Prematurity remains the leading cause of neonatal mortality in the United States
The human milk–based diet (HUM) group had significantly lower incidence of proven necrotizing enterocolitis (NEC) (16.7% versus 6.9%, p < 0.00001), mortality (17.2% versus 13.6%, p = 0.04), late-onset sepsis (30.3% versus 19.0%, p < 0.00001), retinopathy of prematurity (ROP) (9% versus 5.2%, p = 0.003), and bronchopulmonary dysplasia (BPD) (56.3% versus 47.7%, p = 0.0015) compared with the bovine fortifier and/or preterm formula (BOV) group
The continued gain in knowledge over the years has led the American Academy of Pediatrics (AAP) and Surgeon General to recommend in published statements the use of human milk (HM), including donor milk when needed, for premature infants.[4,5]
Summary
Prematurity remains the leading cause of neonatal mortality in the United States. One of the most difficult aspects of the management of the premature infant is related to nutrition and gastrointestinal complications such as necrotizing enterocolitis (NEC) and intestinal perforation. Hair et al demonstrated that the use of an exclusive human milk–based diet (HUM) using mother’s own milk, donor HM, and a donor HM-derived fortifier was safe and did not hinder growth of infants.[6]. There may be multiple benefits in using HM for premature infants such as lower rates of NEC, late-onset sepsis, feeding tolerance, and mortality, along with improved neurodevelopmental outcomes.[7,8,9,10,11] Sullivan et al demonstrated, in a prospective, randomized trial, that the use of breast milk and donor HM with a donor HM-derived fortifier was associated with a reduction in NEC.[12] Given the increasing research showing reduction in NEC rates with an exclusive HUM diet, this study sought to evaluate this trend in multiple centers. The objectives were to determine whether these trends hold true across four Level 3 Neonatal Intensive Care Units at different hospitals in the United States and to evaluate other important outcomes for extremely premature infants
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