370 - Implementation an Exclusive Human Milk Diet in Extreme Premature Infants at a Regional Perinatal Center

An exclusive human milk diet (EHMD) has shown promising results in clinical trials to reduce health complications as well as improved early growth and developmental metrics in Very Low Birth Weight (VLBW) preterm infants compared to traditionally used cow milk based fortifiers added to Mothers Own Milk (MOM) or Donor Human Milk (DHM). Despite emerging evidence from clinical trials supporting the benefits of an EHMD for VLBW preterm infants in the NICU, many barriers prevent its implementation such as limited health economic outcome data and lack of standardized feeding guidelines.

Objective:

The purpose of our study was to compare the feeding tolerance and other short-term outcomes in VLBW infants who received EHMD fortified with Human Milk Based Fortifier (HMBF) with those who received MOM/DHM fortified with Bovine Milk-Based Fortifier (BMBF).

Design/Methods:

We conducted a retrospective chart review that evaluated feeding tolerance specifically assessing time to full feeds, length of TPN use as well as growth (weight gain velocities from birth to discharge) in infants < 1500g in two cohorts before and after the implementation of a standardized feeding protocol for EHMD. Infants who received a mix of breast milk and formula and those with congenital anomalies affecting feeding were excluded.

Results:

The study included 32 infants between gestational ages 22 to 34 weeks and birth weights between 490g and 1500g. Feeding intolerance occurred less often, days on TPN and central line days were shorter (p< 0.05) and length of stay (LOS) was shorter (p< 0.05) in the cohort that received EHMD as seen in Figure 1. The incidence of NEC was lower in the EHMD group but not statistically significant with no difference on growth parameters. We found that implementing the standardized feeding protocol, which included earlier fortification with HMBF to MOM/DHM was associated with decreased LOS.

Conclusion(s):

Our study demonstrated that implementing an EHMD is associated with improved feeding tolerance and had significant reduction in time to reach full enteral feeds as well as shorter LOS in the VLBW population. For future directions, we hope to compare data to evaluate post-discharge growth as well as assess the financial and economic impact based on LOS in premature infants fed EHMD along with its effect on reducing other morbidities such as bronchopulmonary dysplasia and retinopathy of prematurity that comes with extreme prematurity.