Title: Optimizing the Use of Human Milk Cream Supplement in Very Preterm Infants: Growth and Cost Outcomes.

In: Nutrition in Clinical Practice 2020 Aug;35(4):689-696. doi: 10.1002/ncp.10423. Epub 2019 Oct 22.

Authors: Lindsey A Knake, Brian C King, Laura A Gollins, Nancy M Hurst, Joseph Hagan, Steven L Ford, Amy B Hair.

Abstract: "Background: An exclusive human milk-based diet has been shown to decrease necrotizing enterocolitis and improve outcomes for infants ≤1250 g birth weight. Studies have shown that infants who received an exclusive human milk diet with a donor-human milk-derived cream supplement (cream) had improved weight and length velocity when the cream was added to mother's own milk or donor-human milk when energy was <20 kcal/oz using a human milk analyzer. Our objective was to compare growth and cost outcomes of infants ≤1250 g birth weight fed with an exclusive human milk diet, with and without human milk cream, without the use of a human milk analyzer. Methods: Two cohorts of human milk-fed premature infants were compared from birth to 34 weeks postmenstrual age. Group 1 (2010-2011) received a donor-human milk fortifier, whereas Group 2 (2015-2016) received donor-human milk fortifier plus the commercial cream supplement, if weight gain was <15 g/kg/d. Results: There was no difference in growth between the 2 groups for weight (P = 0.32) or head circumference (P = 0.90). Length velocity was greater for Group 1 (P = 0.03). The mean dose of donor-human milk fortifier was lower in Group 2 (P < 0.001). Group 2 saved an average of $2318 per patient on the cost of human milk products (P < 0.01). Conclusions: Infants receiving a human milk diet with cream supplementation for growth faltering achieve appropriate growth in a cost-effective feeding strategy. Keywords: cream; enteral nutrition; human milk; human milk fortifier; human milk supplement; neonates."

Abstract only: https://onlinelibrary.wiley.com/doi/abs/10.1002/ncp.10423

Title: Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk.

In: Breastfeeding Medicine May 2020; 15(5): 297–303.

Authors: Alan Lucas, John Boscardin and Steven A. Abrams.

Abstract: "Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death. Keywords: human milk, infant feeding, human nutrition, fortifiers, human milk-derived fortifier, cow's milk-derived fortifier, necrotising enterocolitis."

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232708/

Title: Necrotizing Enterocolitis Reduction Using an Exclusive Human-Milk Diet and Probiotic Supplementation in Infants With 1000-1499 Gram Birth Weight.

In: Nutrition in Clinical Practice 2020 Apr;35(2):331-334. doi: 10.1002/ncp.10394. Epub 2019 Sep 4.

Authors: Ray Sato, Solyvattey Malai, Behzad Razmjouy.

Abstract: "Background: Necrotizing enterocolitis (NEC) is a major complication confronting clinicians caring for premature infants. This investigation compares clinical outcomes before and after quality improvement-program interventions in a population of premature infants at intermediate risk for NEC. Methods: This study is a retrospective single-center chart review of infants admitted with a birth weight of 1000-1499 g, excluding major congenital anomalies, over a 6-year period, beginning with implementation of a donor breast-milk program when mother's own milk was not available. Infants were separated into 2 epochs, before (July 2012-December 2013) and after (April 2014-June 2018) introduction of human milk-derived fortifier (Prolacta) and a daily probiotic (FloraBABY) supplement. Results: Comparing 140 preintervention infants with 265 postintervention infants, NEC was significantly lower in the postintervention group: 5.2% vs 1.1% (P = 0.046). Somatic growth was similar in both epochs. Conclusions: Quality-improvement initiatives utilizing an exclusive human-milk diet and daily probiotic supplementation were associated with a decreased incidence of NEC in infants with a birth weight of 1000-1499 g. Implementation of the NEC reduction bundle did not affect infant growth. Keywords: human milk; necrotizing enterocolitis; premature infant; probiotics; quality improvement."

Abstract only: https://onlinelibrary.wiley.com/doi/abs/10.1002/ncp.10394