Purpose: Necrotizing enterocolitis (NEC) is a multifactorial disease characterized by intestinal inflammation and injury. Some practices have been reported to reduce the risk of NEC in preterm infants including the use of mother’s own milk or human donor milk feedings, the use of human milk-based rather than bovine-derived human milk fortifiers (HMF), and the adoption of a standardized feeding protocol. We had adopted these practices sequentially in our NICU at UF Health Jacksonville. The purpose of this retrospective study was to compare the NEC rates across intervention periods. Method: Using our perinatal database, we abstracted demographics and outcomes for infants born before 30 0/7 weeks GA and < 1000 g BW from June 2013 to November 2017. We excluded infants who died before 72 hours or who had major congenital or chromosomal abnormalities. We had implemented 2 discrete practice changes in our NICU to improve feeding outcomes: 1) a transition from bovine-derived to human milk-based HMF in March 2015 and 2) adoption of a standardized feeding protocol in August 2016. All infants in cohort 1 (June 2013-February 2015) received human milk or formula plus standard HMF. Infants in cohort 2 (March 2015-July 2016) received human milk + human milk-based HMF. In cohort 3 (August 2016-November 2017), infants were fed as in cohort 2 but using a standardized feeding protocol. We defined NEC using Bell criteria as ≥ stage 2. Results: After excluding 23 infants, we compared the demographics (Table 1) and outcomes (Table 2) of 75, 78 and 69 infants in cohort 1, cohort 2 and cohort 3, respectively. Categorical data are presented as frequencies (percentage) while continuous data are presented using medians (interquartile range). The level of significance was set at P < 0.05. Conclusion: The rate of NEC did not change with the introduction of a human milk-based HMF. However, implementation of a standardized feeding protocol in cohort 3 was associated with a decreased incidence of NEC and need for NEC-related surgery. Infants in cohort 3 also achieved a greater weight by 36 weeks postmenstrual age.

Demographic Characterisitcs

Demographic Characterisitcs

Primary and secondary outcomes

NEC: Necrotizing Enterocolitis; IVH: Intraventricular Hemorrhage; HC: Head Circumference

Primary and secondary outcomes

NEC: Necrotizing Enterocolitis; IVH: Intraventricular Hemorrhage; HC: Head Circumference