Extrauterine Growth Restriction: What Is the Evidence for Better Nutritional Practices in the Neonatal Intensive Care Unit?

Dana Lunde, DNP RNC APRN NNP-BC

Disclosures

NAINR. 2014;14(3):92-98. 

In This Article

The Use of Human Milk and Donor Human Milk

The AAP Section on Breastfeeding recommends human milk as the gold standard for enteral feedings in both term and preterm infants. However, maintaining adequate milk supply for the preterm infant's mother can be quite challenging and often times leads to the premature infant receiving formula feedings over time. Although many preterm formulas have been designed with the appropriate ingredients to meet the premature infant's nutritional needs, its use has been associated with a higher incidence of NEC.[31]

In a 2008 systematic review, Quigley et al. reviewed eight RCTs that compared formula versus donor human milk on growth and development. The meta-analysis of the data showed infants who received formula had improved short-term growth, although donor milk was not nutrient-fortified in the one study included that utilized donor milk. This meta-analysis found infants fed formula were at a statistically significant higher risk of developing NEC in five reviewed trials that included this as an outcome.[32]

In a more recent RCT, Sullivan and colleagues randomized 204 VLBW infants into three different groups. The first group received their own mother's milk or donor milk if mother's milk was not available plus pasteurized donor human milk fortifier once they reached 100 ml kg−1 day−1 of feedings. The second group received own mother's milk or donor milk if mother's milk was not available plus pasteurized donor human milk fortifier once they reached 40 ml kg−1 day−1 of feedings. The third group received their own mother's milk or preterm infant formula if mother's milk was not available; if mother's milk was available it was fortified with bovine human milk fortifier once the infant reached 100 ml kg−1 day−1 of feedings. Those infants who received an exclusive human milk based diet had significantly lower rates of NEC (50% reduction) and lower rates of NEC requiring surgical intervention (90% reduction).[33]

Furthermore, Sullivan and colleagues estimated, in their population, that the number of infants needed to treat with exclusive human milk fed diet to prevent one case of NEC is 10. The number of infants needed to treat to prevent one case of surgical NEC is 8. Based on these estimates and the 50% reduction in NEC seen in this study, an exclusive human milk diet would prevent between 1300 and 1850 cases of NEC annually.[33] Preventing NEC with use of human milk not only decreases mortality but it also has been reported to decrease long-term growth failure and poor neurodevelopmental outcomes commonly seen in small premature infants.[34,35]

In another RCT, Schanler et al. randomized 234 premature infants less than 30 weeks gestation to receive either pasteurized donor human milk or preterm formula if their own mother's milk was not available. Those infants who received donor milk were noted to have a greater intake of milk and higher amounts of nutritional supplements but had slower weight gain when compared to those infants who received the premature formula. However, those infants who received only their mother's own milk had less late onset sepsis especially gram-negative sepsis, shorter hospital stays and a lower incidence of NEC.[36]

Human milk not only decreases the risk of developing NEC but it also decreases the risk of late onset sepsis in premature infants. Cristofalo and associates not only confirm these findings but also found that an exclusive human milk diet significantly decreased the duration of parenteral nutrition. They also recommend that the use of an exclusive human milk diet is optimal for providing adequate nutrition to ELBW infants cared for in the NICU.[37]

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