Exclusively human milk-based diet versus diet of human milk and bovine milk-based products in extremely premature infants

The health benefits of human milk for extremely premature infants have been increasingly recognized. In fact, premature infants have improved feeding tolerance and a lower incidence of late-onset sepsis and necrotizing enterocolitis (NEC) when fed their mothers’ milk than when given preterm formula. However, mothers of extremely premature infants seldom provide sufficient milk to meet their infants’ needs. Therefore, pasteurized donor human milk would be an attractive proxy for mother’s own milk. A meta-analysis suggested that donor milk is associated with a significantly lower incidence of NEC than formula. The examined studies, however, did not include a large proportion of extremely premature infants and their nutritional protocols did not evaluate human milk fortifiers (HMF) or contemporary preterm formula. Thus, no trial conducted so far has investigated the effects of an exclusively human milk diet in extremely premature infants. The technology to collect, pasteurize, and process large quantities of screened donor human milk, labelled with its basic nutrient contents, and prepared as either a HMF or a donor milk alternative to mother’s own milk is however now available.
An American group has conducted a randomized trial to evaluate the health benefits of an exclusively human milk–based diet compared with a diet of both human milk and bovine milk–based products in extremely premature infants fed their own mothers’ milk.
Infants were randomized to 1 of 3 study groups. Groups HM100 (n=67) and HM40 (n=71) received pasteurized donor human milk–based human milk fortifier when the enteral intake was 100 and 40 mL/kg/day, respectively, and both groups received pasteurized donor human milk if no mother’s milk was available. Group BOV (n=69) received bovine milk–based human milk fortifier when the enteral intake was 100 mL/kg/day and preterm formula if no mother’s milk was available. The investigators evaluated duration of parenteral nutrition, morbidity, and growth.
The 3 groups had similar duration of parenteral nutrition, rates of late-onset sepsis, and growth. However, there were fewer cases of NEC in the HM100 and HM40 groups and in the combined exclusive human milk–based diet group (HM100 + HM40) when compared to the BOV group (p=0.02). The number of cases of NEC requiring surgical intervention was significantly lower both in the HM100 and in the HM40 group than in the BOV group (p=0.007). Statistical analysis showed a 77% reduction in the odds of developing NEC while receiving an exclusive human milk diet, when compared to controls.
In conclusion, an exclusively human milk–based diet seems associated with a significant reduction in the rates of NEC and surgical NEC compared with dietary exposure to bovine milk–based products in extremely premature infants.

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