Greater Mortality and Morbidity in Extremely Preterm Infants Fed a Diet Containing Cow Milk Protein Products

Abstract

Background: Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit. Subjects and Methods: EP infants <1,250 g birth weight received a diet consisting of either human milk fortified with a human milk protein-based fortifier (HM) (n = 167) or a diet containing variable amounts of milk containing cow milk-based protein (CM) (n = 93). Principal outcomes were mortality, necrotizing enterocolitis (NEC), growth, and duration of parenteral nutrition (PN). Results: Mortality (2% versus 8%, p = 0.004) and NEC (5% versus 17%, p = 0.002) differed significantly between the HM and CM groups, respectively. For every 10% increase in the volume of milk containing CM, the risk of sepsis increased by 17.9% ( p < 0.001). Growth rates were similar between groups. The duration of PN was 8 days less in the subgroup of infants receiving a diet containing <10% CM versus ‡10% CM ( p < 0.02). Conclusions: An exclusive human milk diet, devoid of CM-containing products, was associated with lower mortality and morbidity in EP infants without compromising growth and should be considered as an approach to nutritional care of these infants.

Risk Factors Related to the Neonatal Mortality in Kurdistan Province, Iran: A Population-Based Case-Control Study

“…Breastfeeding is also introduced by WHO as an effective strategy to reduce the mortality rate (37,38). Moreover, feeding by cow milk is introduced as a risk factor for neonatal mortality in various studies in the world (18,39). According to the IrMIDHS study, the breastfeeding rate was 53.13% in Iran, and 74.82% in Kurdistan province, in 2010 (15).…”

Human Milk Fortification with Bovine Colostrum Is Superior to Formula‐Based Fortifiers to Prevent Gut Dysfunction, Necrotizing Enterocolitis, and Systemic Infection in Preterm Pigs

“…Despite that fortification is widely adopted for very preterm infants fed human milk, there have been concerns that human milk fortification with formula‐based fortifier (FF) increases the risk for necrotizing enterocolitis (NEC) and systemic infections, especially when the dose is high and fortification starts early . Compared with infant formula and FFs, exclusively human milk diet (ie, DHM and human milk‐based fortifier) is associated with less mortality and improved clinical outcomes including NEC in preterm infants . Yet, the application of human milk‐based fortifier is limited by high cost .…”

“…7,8 Compared with infant formula and FFs, exclusively human milk diet (ie, DHM and human milk-based fortifier) is associated with less mortality and improved clinical outcomes including NEC in preterm infants. 9,10 Yet, the application of human milk-based fortifier is limited by high cost. 11 It is therefore important to seek alternatives that support growth and development without additional risks for preterm infants.…”

Variability of Criteria for Pasteurized Donor Human Milk Use

“…It is less clear whether an all–human milk product diet including DHM‐based human milk fortifier rather than bovine‐derived fortifier is similarly cost‐effective. Use of an exclusively human milk–based feeding strategy including mother's own milk, DHM, and DHM‐based human milk fortifier may reduce mortality and incidence of NEC in extremely premature infants 8 , 9 , 30 , 31 and has been estimated to result in direct cost savings of $8167 (2011 U.S.$) per extremely LBW (<1000 g birth weight) infant 26 . However, this estimated savings was sensitive to changes in cost and amount of DHM‐based human milk fortifier provided and required a minimum percentage risk reduction of 54% in both overall NEC and surgical NEC in order for DHM‐based fortifier to remain cost‐effective.…”