An Exclusively Human Milk Diet Reduces Necrotizing Enterocolitis

Overview

Journal Breastfeed Med

Publisher Mary Ann Liebert

Specialty Nutritional Sciences

Date 2014 Mar 5

PMID 24588561

Citations 65

Authors

Kenneth Herrmann

Katherine Carroll

Affiliations

Soon will be listed here.

Abstract

Objective: This study tested the hypothesis that feeding an exclusively human milk (EHM) diet to premature infants reduces the incidence of necrotizing enterocolitis (NEC) associated with enteral feeding.

Study Design: An observational study for infants born at less than 33 weeks of gestational age was performed in a single neonatal intensive care unit. An EHM diet prospectively eliminated bovine-based artificial milk, including bovine-based fortifier, through 33 weeks postmenstrual age (PMA). The clinical data from a 2.5-year interval of the EHM diet were compared with data from the previous 6.5 years for similar infants who received bovine-based milk products before 33 weeks PMA.

Results: In the EHM diet cohort, 148 of 162 infants (91%) received EHM through 33 weeks PMA. In order to achieve an EHM diet, 140 of 162 infants (86%) received their own mother's milk, and 98 of 162 infants (60%) received donor human milk. The EHM cohort was also fed a human milk-based fortifier to truly eliminate bovine products. The distribution of NEC onset in the EHM cohort was significantly different from that in the control cohort for the day of onset (p=0.042) and the PMA at onset (p=0.011). In the control cohort, NEC onset after Day 7 of life occurred in 15 of 443 infants (3.4%), significantly more than in the EHM cohort where NEC occurred in two of 199 infants (1%) (p=0.009).

Conclusions: Changing to an EHM milk diet through 33 weeks PMA reduced the incidence of NEC associated with enteral feeding.

Citing Articles

Thrombin-preconditioned mesenchymal stromal cell-derived extracellular vesicles attenuate experimental necrotizing enterocolitis.

Hwang S, Sung S, Kim Y, Yang M, Koh A, Ahn S Stem Cell Res Ther. 2025; 16(1):101.

PMID: 40022236 PMC: 11871789. DOI: 10.1186/s13287-025-04243-3.

Geospatial determinants and spatio-temporal variation of early initiation of breastfeeding and exclusive breastfeeding in Ethiopia from 2011 to 2019, a multiscale geographically weighted regression analysis.

Tebeje T, Seifu B, Mare K, Asgedom Y, Asmare Z, Asebe H BMC Public Health. 2024; 24(1):2011.

PMID: 39068397 PMC: 11282616. DOI: 10.1186/s12889-024-19552-0.

Personalized Nutrition with Banked Human Milk for Early Gut Microbiota Development: In Pursuit of the Perfect Match.

Hick E, Suarez M, Rey A, Mantecon L, Fernandez N, Solis G Nutrients. 2024; 16(13).

PMID: 38999725 PMC: 11243202. DOI: 10.3390/nu16131976.

Gestational age at birth influences protein and RNA content in human milk extracellular vesicles.

Vahkal B, Altosaar I, Tremblay E, Gagne D, Huttman N, Minic Z J Extracell Biol. 2024; 3(1):e128.

PMID: 38938674 PMC: 11080785. DOI: 10.1002/jex2.128.

Mother's own milk and bronchopulmonary dysplasia in appropriate for gestational age preterm infants.

Correani A, Spagnoli C, Lanciotti L, Monachesi C, Antognoli L, De Angelis F Eur J Clin Nutr. 2024; 78(8):703-708.

PMID: 38816495 DOI: 10.1038/s41430-024-01455-3.

References

Rabe H, Diaz-Rossello J, Duley L, Dowswell T . Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2012; (8):CD003248. DOI: 10.1002/14651858.CD003248.pub3. View

Boyd C, Quigley M, Brocklehurst P . Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2006; 92(3):F169-75. PMC: 2675323. DOI: 10.1136/adc.2005.089490. View

Siggers J, Sangild P, Jensen T, Siggers R, Skovgaard K, Stoy A . Transition from parenteral to enteral nutrition induces immediate diet-dependent gut histological and immunological responses in preterm neonates. Am J Physiol Gastrointest Liver Physiol. 2011; 301(3):G435-45. DOI: 10.1152/ajpgi.00400.2010. View

Sharma R, Hudak M, Tepas 3rd J, Wludyka P, Marvin W, Bradshaw J . Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis. J Perinatol. 2006; 26(6):342-7. DOI: 10.1038/sj.jp.7211510. View

Senterre T, Rigo J . Optimizing early nutritional support based on recent recommendations in VLBW infants and postnatal growth restriction. J Pediatr Gastroenterol Nutr. 2011; 53(5):536-42. DOI: 10.1097/MPG.0b013e31822a009d. View

Dudley M, Wykes L, Dudley Jr A, Burrin D, Nichols B, Rosenberger J . Parenteral nutrition selectively decreases protein synthesis in the small intestine. Am J Physiol. 1998; 274(1):G131-7. DOI: 10.1152/ajpgi.1998.274.1.G131. View

Schanler R, Shulman R, Lau C . Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics. 1999; 103(6 Pt 1):1150-7. DOI: 10.1542/peds.103.6.1150. View

Morgan J, Bombell S, McGuire W . Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev. 2013; (3):CD000504. PMC: 11480887. DOI: 10.1002/14651858.CD000504.pub4. View

Bell M, TERNBERG J, Feigin R, Keating J, Marshall R, Barton L . Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978; 187(1):1-7. PMC: 1396409. DOI: 10.1097/00000658-197801000-00001. View

10.

. Breastfeeding and the use of human milk. Pediatrics. 2012; 129(3):e827-41. DOI: 10.1542/peds.2011-3552. View

11.

Goldstein R, Hebiguchi T, Luk G, Taqi F, Guilarte T, Franklin Jr F . The effects of total parenteral nutrition on gastrointestinal growth and development. J Pediatr Surg. 1985; 20(6):785-91. DOI: 10.1016/s0022-3468(85)80044-0. View

12.

Neu J, Walker W . Necrotizing enterocolitis. N Engl J Med. 2011; 364(3):255-64. PMC: 3628622. DOI: 10.1056/NEJMra1005408. View

13.

Sharma R, Hudak M . A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol. 2013; 40(1):27-51. PMC: 3575605. DOI: 10.1016/j.clp.2012.12.012. View

14.

Boghossian N, Hansen N, Bell E, Stoll B, Murray J, Laptook A . Survival and morbidity outcomes for very low birth weight infants with Down syndrome. Pediatrics. 2010; 126(6):1132-40. PMC: 3059605. DOI: 10.1542/peds.2010-1824. View

15.

Grave G, Nelson S, Walker W, Moss R, Dvorak B, Hamilton F . New therapies and preventive approaches for necrotizing enterocolitis: report of a research planning workshop. Pediatr Res. 2007; 62(4):510-4. DOI: 10.1203/PDR.0b013e318142580a. View

16.

Bjornvad C, Schmidt M, Petersen Y, Jensen S, Offenberg H, Elnif J . Preterm birth makes the immature intestine sensitive to feeding-induced intestinal atrophy. Am J Physiol Regul Integr Comp Physiol. 2005; 289(4):R1212-22. DOI: 10.1152/ajpregu.00776.2004. View

17.

Morgan 3rd W, Yardley J, Luk G, Niemiec P, Dudgeon D . Total parenteral nutrition and intestinal development: a neonatal model. J Pediatr Surg. 1987; 22(6):541-5. DOI: 10.1016/s0022-3468(87)80217-8. View

18.

Henderson G, Craig S, Brocklehurst P, McGuire W . Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case-control study. Arch Dis Child Fetal Neonatal Ed. 2007; 94(2):F120-3. DOI: 10.1136/adc.2007.119560. View

19.

Jones L, Craven P, Attia J, Thakkinstian A, Wright I . Network meta-analysis of indomethacin versus ibuprofen versus placebo for PDA in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2010; 96(1):F45-52. DOI: 10.1136/adc.2009.168682. View

20.

Corpeleijn W, Kouwenhoven S, Paap M, van Vliet I, Scheerder I, Muizer Y . Intake of own mother's milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology. 2012; 102(4):276-81. DOI: 10.1159/000341335. View