Role of human milk in extremely low birth weight infants' risk of necrotizing enterocolitis or death.
ABSTRACT To determine the association between human milk (HM) intake and risk of necrotizing enterocolitis (NEC) or death among infants 401 to 1000 g birth weight.
Analysis of 1272 infants in the National Institute of Child Health and Human Development Neonatal Network Glutamine Trial was performed to determine if increasing HM intake was associated with decreased risk of NEC or death. HM intake was defined as the proportion of HM to total intake, to enteral intake and total volume over the first 14 days. Known NEC risk factors were included as covariates in Cox proportional hazard analyses for duration of survival time free of NEC.
Among study infants, 13.6% died or developed NEC after 14 days. The likelihood of NEC or death after 14 days was decreased by a factor of 0.83 (95% confidence interval, CI 0.72, 0.96) for each 10% increase in the proportion of total intake as HM. Each 100 ml kg(-1) increase in HM intake during the first 14 days was associated with decreased risk of NEC or death (hazard ratio, HR 0.87 (95% CI 0.77, 0.97)). There appeared to be a trend towards a decreased risk of NEC or death among infants who received 100% HM as a proportion to total enteral intake (HM plus formula), although this finding was not statistically significant (HR 0.85 (95% CI 0.60, 1.19)).
These data suggest a dose-related association of HM feeding with a reduction of risk of NEC or death after the first 2 weeks of life among extremely low birth weight infants.
Full-textDOI: · Available from: Ardythe Luxion Morrow, May 22, 2015
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ABSTRACT: Donor milk usage in the United States has increased substantially over the past 10 years. Between 2007 and 2011, donor milk use in level 3 and 4 neonatal ICUs increased from 25 to 45%. Most centers have written protocols based on birth weight or gestational age, and give donor milk in an effort to prevent necrotizing enterocolitis. The evidence for protection against necrotizing enterocolitis using bovine-fortified donor milk vs. formula is limited, although the exclusive human milk diet seems to offer protection compared to diets containing formula. Adequate growth can be achieved with donor milk fortified with either bovine or human milk-derived fortifiers, but use of additional fortification and protein supplementation may be required. Several randomized trials of donor milk vs. formula are ongoing in the very low birth weight population in North America that can answer important questions. Further research is needed before donor milk and the exclusive human milk diet are considered the standard of care.
Newborn and Infant Nursing Reviews 12/2013; 13(4):178-183. DOI:10.1053/j.nainr.2013.09.007
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ABSTRACT: An elevated serum phosphorus (P) has been anecdotally described in premature infants receiving human milk fortified with donor human milk-derived fortifier (HMDF). No studies have prospectively investigated serum P in premature infants receiving this fortification strategy. In this single center prospective observational cohort study, extremely premature infants ≤1250 grams (g) birth weight (BW) were fed an exclusive human milk-based diet receiving HMDF and serum P levels were obtained. We evaluated 93 infants with a mean gestational age of 27.5 ± 2.0 weeks (Mean ± SD) and BW of 904 ± 178 g. Seventeen infants (18.3%) had at least one high serum P level with a mean serum P of 9.2 ± 1.1 mg/dL occurring at 19 ± 11 days of life. For all infants, the highest serum P was inversely correlated to the day of life of the infant (p < 0.001, R2 = 0.175) and positively correlated with energy density of HMDF (p = 0.035). Serum P was not significantly related to gender, BW, gestational age, or days to full feeds. We conclude that the incidence of hyperphosphatemia was mild and transient in this population. The risk decreased with infant age and was unrelated to gender, BW, or ethnicity.Nutrients 04/2015; 7(4):2562-2573. DOI:10.3390/nu7042562 · 3.15 Impact Factor