Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet

Nutr Clin Pract. 2018 Oct;33(5):671-678. doi: 10.1002/ncp.10054. Epub 2018 Feb 16.


Background: An exclusive human milk diet (EHM) fortified with human milk-based fortifier decreases necrotizing enterocolitis (NEC) compared to maternal milk supplemented with preterm formula and bovine fortifier (PTF). Growth has been less with EHM and also maternal milk supplemented with donor human milk and bovine fortifier (HMBF). The objective was to evaluate the effect of a standardized feeding protocol on the growth of infants ≤1250 g birth weight supported with EHM and HMBF. The effect on the incidence of NEC was also evaluated.

Design/methods: A retrospective study of growth before and after implementation of a feeding protocol for infants who received either EHM or HMBF. Primary outcomes were weight, length, and head circumference gain velocities from birth to discharge. The incidence of NEC was also recorded.

Results: Analysis of covariance for 379 total infants showed that earlier day of life for fortification to 24 Kcal/oz was associated with increased weight gain (p = 0.0166) and length gain (p = 0.0064). Implementation of the feeding protocol was associated with increased head circumference gain (p = 0.006). EHM was associated with decreased incidence of NEC (p = 0.0302).

Conclusions: 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.

Keywords: breast milk; breast milk fortification; donor human milk; human milk; infant necrotizing enterocolitis; milk banks.

Publication types

  • Evaluation Study

MeSH terms

  • Animals
  • Birth Weight
  • Body Height
  • Cattle
  • Clinical Protocols
  • Diet
  • Enteral Nutrition / methods*
  • Enterocolitis, Necrotizing / prevention & control*
  • Female
  • Food, Formulated
  • Food, Fortified*
  • Head
  • Humans
  • Infant
  • Infant Formula / chemistry*
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight*
  • Male
  • Milk, Human*
  • Nutritional Status
  • Retrospective Studies
  • Weight Gain*