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Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet.
Nutr Clin Pract. 2018 Oct; 33(5):671-678.NC

Abstract

BACKGROUND

An exclusive human milk diet (EHM) fortified with human milk-based fortifier decreases necrotizing enterocolitis (NEC) compared to maternal milk supplemented with preterm formula and bovine fortifier (PTF). Growth has been less with EHM and also maternal milk supplemented with donor human milk and bovine fortifier (HMBF). The objective was to evaluate the effect of a standardized feeding protocol on the growth of infants ≤1250 g birth weight supported with EHM and HMBF. The effect on the incidence of NEC was also evaluated.

DESIGN/METHODS

A retrospective study of growth before and after implementation of a feeding protocol for infants who received either EHM or HMBF. Primary outcomes were weight, length, and head circumference gain velocities from birth to discharge. The incidence of NEC was also recorded.

RESULTS

Analysis of covariance for 379 total infants showed that earlier day of life for fortification to 24 Kcal/oz was associated with increased weight gain (p = 0.0166) and length gain (p = 0.0064). Implementation of the feeding protocol was associated with increased head circumference gain (p = 0.006). EHM was associated with decreased incidence of NEC (p = 0.0302).

CONCLUSIONS

Implementation of a standardized feeding protocol including earlier fortification of maternal milk was associated with improved growth for infants receiving human milk feedings. EHM significantly decreased NEC. Earlier fortification had no effect on NEC.

Authors+Show Affiliations

Division of Neonatology, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA. Neonatologist, Northwest Newborn Specialists, PC and Peditatrix Medical Group Emanuel, Portland, Oregon, USA.Department of Food and Nutrition Services, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA.Department of Food and Nutrition Services, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA.Devers Eye Institute and Legacy Research Institute, Portland, Oregon, USA.Division of Neonatology, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA. Neonatologist, Northwest Newborn Specialists, PC and Peditatrix Medical Group Emanuel, Portland, Oregon, USA.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

29451716

Citation

Huston, Robert K., et al. "Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 33, no. 5, 2018, pp. 671-678.
Huston RK, Markell AM, McCulley EA, et al. Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet. Nutr Clin Pract. 2018;33(5):671-678.
Huston, R. K., Markell, A. M., McCulley, E. A., Gardiner, S. K., & Sweeney, S. L. (2018). Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 33(5), 671-678. https://doi.org/10.1002/ncp.10054
Huston RK, et al. Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet. Nutr Clin Pract. 2018;33(5):671-678. PubMed PMID: 29451716.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet. AU - Huston,Robert K, AU - Markell,Andrea M, AU - McCulley,Elizabeth A, AU - Gardiner,Stuart K, AU - Sweeney,Sean L, Y1 - 2018/02/16/ PY - 2018/2/17/pubmed PY - 2018/12/20/medline PY - 2018/2/17/entrez KW - breast milk KW - breast milk fortification KW - donor human milk KW - human milk KW - infant necrotizing enterocolitis KW - milk banks SP - 671 EP - 678 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 33 IS - 5 N2 - BACKGROUND: An exclusive human milk diet (EHM) fortified with human milk-based fortifier decreases necrotizing enterocolitis (NEC) compared to maternal milk supplemented with preterm formula and bovine fortifier (PTF). Growth has been less with EHM and also maternal milk supplemented with donor human milk and bovine fortifier (HMBF). The objective was to evaluate the effect of a standardized feeding protocol on the growth of infants ≤1250 g birth weight supported with EHM and HMBF. The effect on the incidence of NEC was also evaluated. DESIGN/METHODS: A retrospective study of growth before and after implementation of a feeding protocol for infants who received either EHM or HMBF. Primary outcomes were weight, length, and head circumference gain velocities from birth to discharge. The incidence of NEC was also recorded. RESULTS: Analysis of covariance for 379 total infants showed that earlier day of life for fortification to 24 Kcal/oz was associated with increased weight gain (p = 0.0166) and length gain (p = 0.0064). Implementation of the feeding protocol was associated with increased head circumference gain (p = 0.006). EHM was associated with decreased incidence of NEC (p = 0.0302). CONCLUSIONS: Implementation of a standardized feeding protocol including earlier fortification of maternal milk was associated with improved growth for infants receiving human milk feedings. EHM significantly decreased NEC. Earlier fortification had no effect on NEC. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/29451716/Improving_Growth_for_Infants_≤1250_Grams_Receiving_an_Exclusive_Human_Milk_Diet_ L2 - https://doi.org/10.1002/ncp.10054 DB - PRIME DP - Unbound Medicine ER -