Team-Based Implementation of an Exclusive Human Milk Diet

Adv Neonatal Care. 2019 Dec;19(6):460-467. doi: 10.1097/ANC.0000000000000676.


Background: The University of Virginia neonatal intensive care unit is a 51-bed unit with approximately 600 to 700 admissions per year. Despite evidenced-based clinical care, necrotizing enterocolitis (NEC) and feeding intolerance remained problematic.

Purpose: In September 2016, the neonatal intensive care unit implemented an exclusive human milk diet (EHMD) for infants born 1250 g or less with the goal of reducing NEC, feeding intolerance, parenteral nutrition use, and late-onset sepsis. Length of stay, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity were also evaluated.

Methods: A work group developed systems for charging and documenting products used in an EHMD. Outcomes were compared with a control group of similar infants born prior to the availability of the EHMD.

Results: Infants who received an EHMD had significantly fewer late-onset sepsis evaluations (P = .0027) and less BPD (P = .018). While not statistically significant, less surgical NEC was also demonstrated (4 cases vs 1 case, which was 57% of total NEC cases vs 14.3%) while maintaining desirable weight gain and meeting financial goals.

Implications for practice: A multidisciplinary team that implements financial and documentation systems can provide a sustainable clinical practice that improves patient outcomes. Ongoing evaluations of clinical and financial data provide valuable information to guide future clinical practices related to the EHMD.

Implications for research: Future research on the anti-inflammatory effect of an EHMD is needed to provide direction regarding a potential dose-dependent response for reduced BPD rates and severity. The role of human milk and prevention or mitigation of sepsis is not fully understood, but the reduction of the number of late-onset sepsis evaluations may support the relationship between an EHMD and infection protection. Exploring clinical and financial outcomes for implementing the EHMD in infants born more than 1250 g remains a key area for research.

MeSH terms

  • Diet Records
  • Enterocolitis, Necrotizing* / diet therapy
  • Enterocolitis, Necrotizing* / prevention & control
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases* / diet therapy
  • Infant, Premature, Diseases* / prevention & control
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Intensive Care, Neonatal* / economics
  • Intensive Care, Neonatal* / methods
  • Male
  • Milk, Human*
  • Monitoring, Physiologic / methods
  • Monitoring, Physiologic / statistics & numerical data
  • Neonatal Sepsis / prevention & control*
  • Outcome and Process Assessment, Health Care