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Title: An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products

Author
item SULLIVAN, SANDRA - University Of Florida
item SCHANLER, RICHARD - Schneider Children'S Hospital
item KIM, JAE - University Of California
item PATEL, ALOKA - Rush University Medical Center
item TRAWOGER, RUDOLF - Innsbruck Medical University
item KIECHL-KOHLENDORFER, URSULA - Innsbruck Medical University
item CHAN, GARY - University Of Utah
item BLANCO, CYNTHIA - University Of Texas Health Science Center
item ABRAMS, STEVEN - Children'S Nutrition Research Center (CNRC)
item COTTEN, C - Duke University Medical Center

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/29/2009
Publication Date: 4/1/2010
Citation: Sullivan, S., Schanler, R.J., Kim, J.H., Patel, A.L., Trawoger, R., Kiechl-Kohlendorfer, U., Chan, G.M., Blanco, C.L., Abrams, S., Cotten, C.M. 2010. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. Journal of Pediatrics. 156(4):562-567

Interpretive Summary: Using breast milk to feed premature infants has many potential health benefits. We wanted to know if giving these babies only breast milk, and avoiding any cow milk protein would lower the risk of a severe intestinal disorder called necrotizing enterocolitis. We enrolled infants whose mothers planned to breast feed and randomized them to get only human milk or to receive some cow milk protein as a fortifier for human milk or if the mother did not provide enough milk. We found that the group of infants fed an exclusively human milk diet had significantly lower rates of necrotizing enterocolitis, and NEC requiring surgical intervention. We concluded that for extremely premature infants, an exclusively human milk–based diet is associated with significantly lower rates of NEC and surgical NEC when compared with a mother’s milk–based diet that also includes cow milk–based products.

Technical Abstract: To evaluate the health benefits of an exclusively human milk–based diet compared, with a diet of both human milk and bovine milk–based products in extremely premature infants. Infants fed their own mothers’ milk were randomized to 1 of 3 study groups. Groups HM100 and HM40 received pasteurized donor human milk–based human milk fortifier when the enteral intake was 100 and 40 mL/kg/d, respectively, and both groups received pasteurized donor human milk if no mother’s milk was available. Group BOV received bovine milk–based, human milk fortifier when the enteral intake was 100 mL/kg/d and preterm formula if no mother’s milk was available. Outcomes included duration of parenteral nutrition, morbidity, and growth. The 3 groups (total n = 207 infants) had similar baseline demographic variables, duration of parenteral nutrition, rates of late-onset sepsis, and growth. The groups receiving an exclusively human milk diet had significantly lower rates of necrotizing enterocolitis (NEC; P = .02), and NEC requiring surgical intervention (P = .007). For extremely premature infants, an exclusively human milk–based diet is associated with significantly lower rates of NEC and surgical NEC when compared with a mother’s milk–based diet that also includes bovine milk–based products.