Poster Topical Area: Maternal, Perinatal and Pediatric Nutrition

Location: Hall D

Poster Board Number: 255

E04-02 - Exclusively Human Milk Diets for Preterm Infants: five-year outcomes

Sunday, Jun 10
8:00 AM – 6:00 PM

Objectives: Exclusively human milk (EHM) diets for preterm infants have been associated with shorter hospital stays, sustained growth, and lower rates of necrotizing enterocolitis (NEC). In 2012, the preterm NEC rate in our 50-bed neonatal intensive care unit (NICU) was high (14.5% of infants with very low birthweight [BW] <1500g) compared to national data. In order to improve patient outcomes, we began a policy of EHM for these high-risk patients. We present the 5-year experience (2013-2017).

Methods: EHM diets require feeding only mother’s expressed milk (when available) or donor human milk (DHM) as well as supplementing HM only with HM-derived fortifiers (e.g., Prolact+ &/or Cream). In our NICU, adoption of EHM diets occurred in a stepwise fashion. Initially, we presented hospital administration and the Board of Directors with a cost/benefit analysis derived from the estimated decline in NEC cases projected for EHM-fed infants with BW <1000 g (based on then-available data), estimated number of “excess” NEC cases, and costs per patient for “medical” and “surgical” NEC (NICU costs, hospital length of stay [LOS]). Review of several months of data in year 1 indicated no new NEC cases in patients <1000g (the highest risk group), but continued occurrence of NEC in infants with BW 1001-1500g. Subsequently, EHM diets were adopted, first for infants <1250g, then for infants <1500g.

Results: Results from this 5-year, stepwise adoption of EHM diets for very low BW infants include a dramatic decline in NEC (Bell’s Stage 2 or greater) from 14.5% to 0-3% (2015-2017). Other outcomes (compared to previous years’ data) include comparable growth and significant decreases in: LOS, days of parenteral nutrition, days with an indwelling central venous catheter, and days of antibiotic administration (means). We observed elimination of deaths from NEC and declines in long-term morbidity and NICU costs.

Conclusions: The stepwise process of adoption of EHM is instructive for centers adopting this nutritional approach. It has facilitated examining staged improvements in outcomes. EHM diets for preterm infants are a practical nutritional strategy to improve survival and health and decrease hospital-related morbidities in this high-risk neonatal population. 

CoAuthors: Amanda Timmerman, MS, RD, CSP, CNSC, LD – El Paso Children's Hospital

Lewis P. Rubin

Professor and Vice Chair of Pediatrics
El Paso, Texas