, et al
An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milkbased product
J Pediatr
; doi:

Investigators at 12 neonatal intensive care units, 11 in the US and one in Austria, conducted a randomized trial in premature infants to evaluate the health benefits of a diet consisting exclusively of human milk compared with a diet of both human milk and bovine milk-based products. Infants with birth weights between 500 to 1250 g born to mothers who intended to breastfeed were assigned to one of three groups. Two of the study groups, HM100 and HM40, received pasteurized donor human milk-based human milk fortifier (HMF) when the infant’s enteral intake was 100 and 40 mL/kg/d, respectively, and received pasteurized donor human milk if no mother’s milk was available. The third group, BOV, received bovine HMF when the enteral intake was 100 mL/kg/d and preterm formula if no mother’s milk was available. Parenteral nutrition was initiated within 48 hours after birth and trophic feedings, 10 to 20 ml/kg/day of gut-priming nutrients, were initiated from one to four days after birth and continued for up to five days. Milk intake was then increased by 10 to 20 ml/kg/d. The primary outcome studied was duration of parenteral nutrition, as a surrogate for feeding intolerance and neonatal morbidity. Other outcome measures included late-onset sepsis, necrotizing enterocolitis (NEC), and growth. Study participation concluded when one of the following milestones was achieved: 91 days of age, discharge from hospital, or attainment of 50% oral feedings.

A total of 207 infants with a mean gestational age of 27.2 weeks were enrolled. There was no significant difference in duration of parenteral nutrition, length of stay, incidence of late-onset sepsis, or growth. No differences were seen between the two groups receiving exclusively human milk (HM100 and HM40). Compared to the bovine milk supplement group, the two groups receiving an exclusively human milk diet had lower rates of NEC (P=.02) and NEC requiring surgical intervention (P=.007). When controlling for variables known to affect the incidence of NEC, there was a 77% reduction in the odds of developing NEC while receiving an exclusively human milk diet.

The authors conclude that an exclusively human milk-based diet is associated with significantly lower rates of NEC and surgical NEC when compared with a diet of both human and bovine milk-based products.

Meta-analyses have shown that preterm infants fed formula rather than human milk have a significantly higher incidence of NEC.1,2 Feeding these infants human milk exclusively, however, is a challenge, due to the difficulty of pumping sufficient milk and the need to fortify human milk to meet the nutritional needs of these infants. Many nurseries promote the use of mother’s milk, but fortify the milk with bovine HMF and feed...

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