Effect of an exclusive human milk diet on feeding tolerance in preterm infants

El-Fadeel, Hiba; Velumula, Pradeep Kumar; Lulic-Botica, Mirjana; Natarajan, Girija; Thomas, Ronald; Botica, Gabriella; Bajaj, Monika

doi:10.1038/s41372-022-01348-y

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Our data provides further support of trends identi ed in other studies, [38][39][40]43,44 including that growth in weight, length, and head circumference on an EHMD diet is comparable to that on a formula or bovineforti ed diet. This contradicts other studies about growth outcomes related to breastmilk versus formula or bovine forti cation in this population 35,36 but may be attributable to forti cation in the post-EHMD group taking place an average of almost 8 days earlier than in the pre-EHMD group.…”

Section: Discussionsupporting

confidence: 90%

“…Though this was not evaluated in this study, but some literature does support improved feeding tolerance with an EHMD. 37,39 Additionally, a decrease incidence in NEC would translate to fewer antibiotic days.…”

Section: Discussionmentioning

confidence: 99%

“…36 However, other studies suggest than an exclusive human milk diet (EHMD: MOM or DHM forti ed with human milk-based forti er) improves feeding tolerance and NEC without detrimental effects on growth compared to human milk forti ed with bovine-based forti ers and/or preterm formula. [37][38][39][40] The neonatal intensive care unit (NICU) at El Paso Children's Hospital (EPCH) opened in 2012. Nutrition for VLBWs at that time was based on MOM with bovine-based forti er or preterm formula if MOM was not available.…”

Section: Introductionmentioning

confidence: 99%

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Improved Outcomes and Reduced Costs: Exclusive Human Milk Diet for Very Low Birth Weight Infants at a Single Center

Mudekunye,

Tullius,

Guevara

et al. 2024

Preprint

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Preterm infants born at very low birth weight (VLBW) are at increased risk of developing many highly morbid conditions such as necrotizing enterocolitis (NEC), periventricular leukomalacia (PVL), and retinopathy of prematurity (ROP). This leads to a significant emotional and cost burden for their families and the healthcare system. Previous literature has established that an exclusive human milk diet (EHMD) when compared to a diet containing bovine milk is associated with decreased incidence of several of these life-threatening conditions. This single center retrospective review at a hospital on the US-Mexico Border compares outcomes of VLBW infants pre- and post- initiation of an EHMD. Infants following an EMHD feeding protocol began fortification on average three days earlier and had their first feeds earlier. The EHMD group had lower incidences of both surgical and medical necrotizing enterocolitis (NEC), and fewer total parenteral nutrition (TPN), central venous line (CVL), and antibiotic days and fever blood transfusions with comparable growth outcomes. In aggregate, this yielded a substantial cost savings.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improved Outcomes and Reduced Costs: Exclusive Human Milk Diet for Very Low Birth Weight Infants at a Single Center

Mudekunye,

Tullius,

Guevara

et al. 2024

Preprint

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“…Outcomes (see Table 1) were selected based on literature from preterm, term, or other neonatal surgical populations demonstrating associations between HM and NEC, 16,17,[24][25][26] infection, 27 sepsis, 17,28 time to full feeds, [29][30][31] feeding-related complications, 29,31 hospital length of stay, 29,30,32 and all-cause mortality. 17,19 Our approach to transformation of variables including prematurity, infant race, insurance type, weight-for-age (WAZ) and length-for-age (LAZ) z-scores, and social determinants of health (ie, rural-urban commuting area, median income of residential area, and social deprivation index (SDI)) 33 has been previously described.…”

Section: Methodsmentioning

confidence: 99%

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Elgersma

Wolfson

Fulkerson

et al. 2023

Preprint

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Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016?2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results: Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17?0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78?0.98, p=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative NEC (OR=0.28, 0.15?0.50, p<0.001) and sepsis (0.29, 0.13?0.65, p=0.003), and shorter S1P LOS (RR=0.75, 0.66?0.86, p<0.001). At S2P, infants with any HM (0.82, 0.69?0.97, p=0.018) and any BF (0.71, 0.57?0.89, p=0.003) experienced shorter LOS. Conclusions: Infants with SV CHD in high HM and BF groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/BF in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader CHD populations, and should examine mechanisms (eg, HM components; microbiome) by which HM/BF benefits these infants.

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“…Outcomes (see Table 1 ) were selected based on literature from preterm, term, or other neonatal surgical populations demonstrating associations between HM and NEC, 16 , 17 , 24 , 25 , 26 infection, 27 sepsis, 17 , 28 time to full feeds, 29 , 30 , 31 feeding‐related complications, 29 , 31 hospital length of stay, 29 , 30 , 32 and all‐cause mortality. 17 , 19 Our approach to transformation of variables including prematurity, infant race, insurance type, weight‐for‐age and length‐for‐age Z scores, and social determinants of health (ie, rural–urban commuting area, median income of residential area, and social deprivation index) 33 has been previously described.…”

Section: Methodsmentioning

confidence: 99%

Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry

Elgersma,

Wolfson,

Fulkerson

et al. 2023

JAHA

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Background Infants with single ventricle congenital heart disease undergo 3 staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding on outcomes including necrotizing enterocolitis, infection‐related complications, length of stay, and mortality. Methods and Results We analyzed the National Pediatric Cardiology Quality Improvement Collaborative (NPC‐QIC) registry (2016–2021), examining HM/breastfeeding groups during stage 1 and stage 2 palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity‐matched cohorts. Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/breastfeeding groups. Infants fed exclusive HM before stage 1 palliation (S1P) had lower odds of preoperative necrotizing enterocolitis (odds ratio [OR], 0.37 [95% CI, 0.17–0.84]; P =0.017) and shorter S1P length of stay (rate ratio [RR], 0.87 [95% CI, 0.78–0.98]; P =0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative necrotizing enterocolitis (OR, 0.28 [95% CI, 0.15–0.50]; P <0.001) and sepsis (OR, 0.29 [95% CI, 0.13–0.65]; P =0.003), and shorter S1P length of stay (RR, 0.75 [95% CI, 0.66–0.86]; P <0.001). At stage 2 palliation, infants with any HM (RR, 0.82 [95% CI, 0.69–0.97]; P =0.018) and any breastfeeding (RR, 0.71 [95% CI, 0.57–0.89]; P =0.003) experienced shorter length of stay. Conclusions Infants with single ventricle congenital heart disease in high‐HM and breastfeeding groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/breastfeeding in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader congenital heart disease populations, and should examine mechanisms (eg, HM components, microbiome) by which HM/breastfeeding benefits these infants.

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Effect of an exclusive human milk diet on feeding tolerance in preterm infants

Cited by 5 publications

References 32 publications

Improved Outcomes and Reduced Costs: Exclusive Human Milk Diet for Very Low Birth Weight Infants at a Single Center

Improved Outcomes and Reduced Costs: Exclusive Human Milk Diet for Very Low Birth Weight Infants at a Single Center

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry

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