Human Milk and the Premature Infant

Abstract

Human milk is the preferred feeding for both term and preterm infants. While being considered optimal for term infants, human milk, even from mothers delivering preterm infants, is lacking in protein, energy, sodium, calcium, and phosphorus, resulting in poorer growth and nutrient deficiencies when compared to formulas designed for these high-risk infants. Further, the lack of growth is associated with long-term adverse consequences. Since human milk has unique properties in promoting gastrointestinal maturation and immunological benefits, it is prudent to implement strategies to fortify it appropriately to realize its benefits which include reduced rates of necrotizing enterocolitis, fewer episodes of sepsis and urinary tract infections, and improved visual and neurocognitive development. Donor human milk is being widely used when mothers' own milk is not available or is in short supply. While it retains some of the biological properties and clinical benefits of mothers' own milk, it requires additional care in fortification, especially if the donor milk is from a pool of term human milk. As nutritional strategies improve, the ultimate goal is to minimize extrauterine growth restriction and promote appropriate growth after regaining birth weight.

Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized Controlled Trial

“…Following delivery, human milk and associated melatonin levels may also be important for infant development (Arslanoglu et al, ; Cubero et al, ). Human milk consumption during hospitalization is associated with greater weight gain, shorter LOS, and fewer hospital costs (Bhatia, ). Few nurseries attempt to provide human milk to infants at the time of day it was pumped, but newer nursery designs including single care‐by‐family rooms may make provision of human milk at the time of day it is pumped more feasible.…”

Effects of a Breast Milk Diet on Enteral Feeding Outcomes of Neonates with Gastrointestinal Disorders

“…1,5,6 In particular, BM diets in premature infants decrease the incidence of late-onset sepsis and necrotizing enterocolitis, increase intestinal motility and gastric emptying, and have general anti-inflammatory effects. 5,7 Studies have also supported the role of BM diets in decreasing PN courses by more than 50% in infants with short bowel syndrome. 1 Furthermore, BM diets are associated with decreased time to full enteral feeds and decreased hospital length of stay (LOS) in select populations.…”

“…1 Furthermore, BM diets are associated with decreased time to full enteral feeds and decreased hospital length of stay (LOS) in select populations. 5,[7][8][9][10][11] We believe that decreasing the time that neonates with GI disorders spend on PN will improve clinical outcomes and decrease overall costs. While there is literature to support this conclusion in preterm and very low-birthweight neonates, there is a paucity of literature assessing the role of BM diets on outcomes of neonates who do not meet such criteria.…”

“…While there is literature to support this conclusion in preterm and very low-birthweight neonates, there is a paucity of literature assessing the role of BM diets on outcomes of neonates who do not meet such criteria. 5,[7][8][10][11][12][13][14] The objective of this study was to assess whether a diet of ‡50% BM is associated with an earlier transition off of PN in neonates with specific GI disorders when compared to similar neonates who receive enteral diets <50% BM. Secondary outcomes included hospital LOS and days to achievement of full enteral feeds.…”

Perinatal Cytomegalovirus and Varicella Zoster Virus Infections

“…While breast milk transmission of CMV is asymptomatic in full-term infants, postnatal acquisition in very low-birth-weight premature infants can be associated with a sepsis-like illness with sequelae including pneumonitis, enteritis, thrombocytopenia, and hepatitis [6, 7]. Although transfusion-associated postnatal CMV infection of premature infants has nearly been eliminated by the use of leukoreduced and CMV-seronegative blood products, encouragement of breast milk feeding to improve health outcomes for premature infants has potentiated the need to address breast milk transmission of CMV in neonatal intensive care settings [8]. However, it remains unclear if postnatal CMV infection of premature infants results in long-term deficits.…”