An Evaluation of Three Nutritional Feedings in Extremely Premature Infants

Purpose:
The purpose was to evaluate the effect of exclusive human breast milk and human-based human milk fortifier (HMF), human breast milk and bovine-based HMF, and exclusive premature formula on the incidence of necrotizing enterocolitis (NEC) in premature infants.

Background/Significance:
Nutritional management of the premature infant is complicated by an immature gastrointestinal system that increases the risk for developing NEC. NEC is associated with longer length of stay, higher rates of mortality and morbidity, and higher hospital costs. Further research is needed to support exclusive human breast milk and human milk-based HMF as an adjunct to feeding the premature infant.

Methods:
A retrospective cohort study was conducted at two community hospital's neonatal intensive care units located in the Southeast. A total of 141 infants weighing 400 to 1250 grams at birth until 34 weeks adjusted gestational age were included in one of three groups that adhered to a feeding protocol and fed exclusive human breast milk and human-based HMF, human breast milk and bovine-based HMF, or premature formula.

Results:
A logistic regression model, using Apgar score and birth weight as covariates to control for group differences, found no significant treatment effect on the likelihood of NEC across the groups x2 (2) = 5.55, P > .05. The bovine-based HMF group was more likely to develop late-onset sepsis than the formula and human-based HMF groups x2 (1) = 5.48 P < .01. The bovine-based HMF group was at a significantly greater risk of developing late-onset sepsis. Although not significant, the bovine-based HMF group was more likely to develop NEC.

Conclusions and Implications for Practice:
Nutritional interventions could have significant effects on the morbidity and mortality of the premature infant.Findings suggests that the use of an exclusive human milk diet could decrease the number of days to reach full feedings, decrease the incidence of sepsis and NEC, and the disease severity.