Improving Outcomes in Premature Infants:
“Exclusive Human Milk Diet”
An exclusive
human milk diet is exactly that: giving
nothing to a newborn but human milk.
We preach it. We tell everyone who will listen that the American Academy
of Pediatrics, the CDC, the WHO, and even the Joint Commission {small shiver up
my spine- if you are in healthcare, you’ll get that} want us to help each new
mother exclusively breastfeed for 6 months.
The key word
there is exclusive.
Hospitals are measuring exclusive breastfeeding rates because of the
Joint Commission Perinatal Core Measure that asks them to start paying attention
to what is, right now, an abysmal number. The CDC has and continues to measure
exclusive breastfeeding rates at several time points from birth to 6 months.
Exclusive breastfeeding for 6 months!
What a task that is in the United States.
However,
many more decision-makers are starting to see that the daunting prospect of
exclusive breastfeeding for 6 months is not just the responsibility of that new
mother. We have an army of people helping on so many fronts, ready with
toolkits, education and enthusiasm. We have dedicated (and probably frustrated)
people lobbying for extended maternity leave.
All of this effort is to establish an infrastructure around a new family,
helping them to achieve their breastfeeding goals, to remove obstacles and to
help increase exclusive breastfeeding duration rates.
All of the good things we know happen because of human milk feeding are
related to how long a baby is breastfed.
No other population needs this help and support more than the family of
the extremely premature infant (those infants
born before 28 weeks of gestation).
Premature
infants are at risk for a host of problems. Among others, premature infants are
at risk for feeding intolerance, late-onset sepsis, and necrotizing
enterocolitis (NEC). NEC is an awful inflammation of the gut, which can lead to
surgery, sepsis and death. I used
to play a neonatologist on TV (I did not complete my fellowship in neonatal-perinatal
medicine, but I learned a lot during the time I was there) and I have a healthy
fear of what that disease does to the baby and the family.
Human milk decreases gastric pH, improves gut flora, decreases gut permeability,
matures the mucosal immune system, prevents invasion of bacteria. All of those
properties help prevent NEC in premature infants. Premature infants getting
human milk at discharge from NICU have
increased IQ points and
growth of brain white matter.
Obviously, the early diet of these babies affects their long-term
outcome; the more human milk they get, the less risk of serious complications.
Great, but
often the mothers of those preterm infants cannot provide enough milk for their
babies.
A 2005 study showed that about
30% mothers of premature infants were able to
give all of the milk their premature baby needed. Enter donor human milk,
donated by breastfeeding mothers to human milk banks to be pasteurized and most
often used to help fill the gap between mother’s own milk and that premature
baby’s needs.
Again, great, but even if that premature infant could get all their feedings
from their mother’s own milk,
human milk protein content decreases over time,
which is fine in healthy, term newborns, but not for preemies who need more
protein than human milk has in order to grow. Preemies also need more fat,
sodium, calcium, and phosphorus. Hence, human milk given to extremely premature
infants needs to be fortified. However, many concerns about fortifiers (ex:
powdered ones have potential for contamination) exist.
The fortifiers are also concerning because they are cow’s milk based.
Early studies looking at the benefits of donor milk in the NICU and found that
it was of limited value may have been confounded by the use of fortifiers that
were cow’s milk based.
What if we were to give nothing but human milk, with human milk based fortifiers
rather than those based on cow’s milk? That would be the very definition of an
exclusive human milk diet and it works really well.
This study
concluded that for “extremely premature infants, an exclusively human milk-based
diet is associated with significantly lower rates of NEC and surgical NEC when
compared with a mother's milk-based diet that also includes bovine milk-based
products.”
The results intuitively make sense. This is really exciting news for all of us
who really care about the health and outcomes of extremely premature infants.
A post-script…Currently, the only manufacturer of the human-milk based human
milk fortifier is Prolacta, which was and really had to be a part of the study.
When I first heard of them, they had sales reps that didn’t know anything about
the product, had no research to support the work they were doing and in general
were pretty clueless. Now, they have great research to support their fortifier.
They have severed their ties with
Similac maker, Abbott, and they are a safe and credible place to donate breast
milk. What I am saying is that they are not the Prolacta of the past and a knee
jerk response of dismissing them now is uninformed.
If you are a mother looking to donate extra breast milk, yes!
Thank you.
You have many choices to help those fragile premature infants including
any one of
HMBANA’s growing number of milk banks, and yes, Prolacta.
(And no, they didn’t pay me.)
Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM
Follow Me: LMC Breastfeeding