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.

Objective: The purpose of this study is to report our experience with an exclusive human milk–based diet (EHM) versus diets of mother’s milk supplemented with banked human milk (DHM) or formula (PTF) plus bovine fortifier. Second, we evaluated the cost-effectiveness of using EHM. Design/Methods: This is a retrospective study of infants ≤1500 g birth weight (VLBW) admitted to the NICU from January 1, 2007, to December 31, 2011. Primary outcomes were rates of Bell stage 2 to 3 necrotizing enterocolitis (NEC) and NEC plus significant gastrointestinal bleeding (GIB). There were 3 groups for analysis according to diet: PTF, DHM, and EHM. Binary outcomes were analyzed using a multivariate logistic regression. Linear analysis of covariance was used to analyze continuous outcomes. Cost analysis used costs from a previous study for stage 2 and 3 NEC and from a matched control analysis for infants in our study for stage 1 NEC. Results: Infants who received EHM (n = 44) had higher rates of risk factors for NEC compared with DHM (n = 224) and PTF (n = 93). Rates of NEC were decreased for EHM versus PTF (odds ratio [OR] = 0.060; confidence interval [CI] = 0.003-0.445; P = .019) and NEC plus GIB were decreased for EHM versus DHM (OR = 0.070; CI = 0.004-0.369; P = .012) and EHM versus PTF (OR = 0.062; CI = 0.003-0.366; P = .011). A cost saving was shown when using EHM for VLBW infants with several risk factors for NEC but not all VLBW infants. Conclusions: EHM lowered the incidence of NEC compared with PTF and NEC plus GIB compared with DHM and PTF. Using EHM in VLBW infants at higher risk of NEC appears to be cost-effective.