100% human milk diet: an integral part of nutrition management in NICU: PAN India neonatologist’s survey

Background: Exclusive human milk diet (EHMD) benefits preterm infants the most, particularly in neonatal intensive care unit. EHMD is dependent on multiple factors consisting of breastfeeding awareness, availability of pasteurized donor human milk, functioning human milk banks and infrastructure. Neonatal nutritional practice varies considerably in India. The aim of this survey was to understand the implementation and benefits of 100% human milk diet through human milk derived nutritional products in preterm infants from NICU experts’ perspective.Methods: The online survey questionnaire formulated and reviewed by the expert neonatologists was shared with the NICU experts pan India through multiple communication channels and referrals. The survey was constructed on the Google Forms platform, the responses was collected between May 2020 to July 2020.Results: A total of 100 neonatologists responded to the survey from 79 hospitals and 31 cities across India. All the respondents (100%) opined that EHMD is important for preterm infants, 15% opined that EHMD was ensured to all preterm infants, 80% opined that human milk-based fortifier (HMBF) was safe and well tolerated by premature infants, 17% reported that 51-80% of preterm infants experience feed intolerance issues with bovine milk based fortifiers (BMBF), blood urea nitrogen (49%) was chosen as an optimal biochemical parameter for assessing protein utilization in NICU, 93% opined that post discharge nutritional supplementation is required for preterm infants among which 49% respondents opined that HMBF and human milk 70 calorie sachet would be preferable as post discharge nutritional supplementation.Conclusions: EHMD unequivocally offers multiple benefits to preterm infants and hence needs to be included in the NICU protocol, availability of human milk derived nutritional products such as HMBF are termed safe and well tolerated and would aid in implementing EHMD in NICUs. Pasteurized donor human milk is vital for ensuring EHMD, thus access to the same needs to be empowered by strengthening the human milk donation and awareness measures.

Download Full-text

Growth, Body Composition, and Neurodevelopmental Outcomes at 2 Years Among Preterm Infants Fed an Exclusive Human Milk Diet in the Neonatal Intensive Care Unit: A Pilot Study

Breastfeeding Medicine ◽

10.1089/bfm.2019.0210 ◽

2020 ◽

Vol 15 (5) ◽

pp. 304-311 ◽

Cited By ~ 1

Author(s):

Erynn M. Bergner ◽

Roman Shypailo ◽

Chonnikant Visuthranukul ◽

Joseph Hagan ◽

Andrea R. O'Donnell ◽

...

Keyword(s):

Intensive Care Unit ◽

Body Composition ◽

Intensive Care ◽

Pilot Study ◽

Neonatal Intensive Care Unit ◽

Human Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Milk Diet ◽

Neurodevelopmental Outcomes

Download Full-text

Nutritional management of preterm newborn after hospital discharge: energy and nutrients

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2017.170 ◽

2017 ◽

Cited By ~ 1

Author(s):

Elisabetta Villa ◽

Roberta Barachetti ◽

Mario Barbarini

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Convincing Evidence ◽

The Body ◽

Post Discharge ◽

Poor Growth ◽

Preterm Babies

Preterm infants are at risk for poor growth while in the Neonatal Intensive Care Unit (NICU) and after discharge from the NICU. The main objective is to reach the body composition and rate of growth of a normal fetus/infant of the same post-menstrual age during the first entire year of life. In case of human milk, the limited data do not provide convincing evidence that feeding preterm infants after discharge with multi-nutrient fortified human milk, compared with unfortified, affects important outcomes including growth rates during infancy. Conversely, if formula-fed, post discharge formulas produce short term advantages in growth rate but no long term advantages are demonstrated. It is very important to establish a feeding plan and a follow up for all preterm babies who are discharged from NICU in order to recognize as soon as possible any growth deficit.

Download Full-text

Antimicrobial Effect of Zn2+ Ions Governs the Microbial Quality of Donor Human Milk

Foods ◽

10.3390/foods10030637 ◽

2021 ◽

Vol 10 (3) ◽

pp. 637

Author(s):

Carmel Hutchings ◽

Zafnat Prokocimer Yair ◽

Ram Reifen ◽

Moshe Shemesh

Keyword(s):

Human Milk ◽

Neonatal Intensive Care ◽

Bovine Milk ◽

Antimicrobial Effect ◽

Older Children ◽

Coagulase Negative Staphylococci ◽

Donor Human Milk ◽

Microscopic Evaluation ◽

Severe Infections ◽

High Doses

Donor human milk (HM) obtained at HM banks is exceptionally crucial for the feeding and treatment of preterm infants. Bacterial contaminations of HM in various stages of its handling are very common and can lead to disqualification of donations or severe infections in worse cases. Hence, HM donations are subject to strict bacteriological evaluations pre- and post-pasteurization. The main contaminating species vary between countries, banks and donors and even exhibit inter-individual variation. We initiated an assessment of the bacteriological composition of HM donated by women hospitalized in a neonatal intensive care unit in Israel. The most common bacterium identified was Staphylococcus epidermidis, found in all but one of the HM samples; the presence of several species of coagulase-negative Staphylococci was also noted. Next, we sought to develop a platform towards antibacterial treatment using Zn2+ ions that have recently been found to be potent against contaminants isolated from bovine milk. Zn2+ efficiently inhibited the growth of viable aerobic population and S. epidermidis in HM. Growth was also inhibited in other Gram-positive bacteria such as Bacillus cereus, a well-known food-borne pathogen. S. epidermidis and B. cereus cells grown in the presence of zinc were taken for microscopic evaluation, aiming to demonstrate zinc’s antimicrobial mode of action morphologically. Images obtained using scanning electron microscopy indicated leakage of cellular content and cell lysis in S. epidermidis. Besides, B. cereus cells showed abnormalities in their cell surface and complete loss of flagella upon treatment with zinc. Along with the above findings, it should be noted that this was a pilot study that tested how high doses of Zn2+ affect breast milk as a product. Further research is likely needed on the safety of consumption of Zn2+-treated HM in infants and older children.

Download Full-text

A clinical audit of the growth of preterm infants fed predominantly pasteurised donor human milk v. those fed mother’s own milk in the neonatal intensive care unit

British Journal Of Nutrition ◽

10.1017/s0007114519000357 ◽

2019 ◽

Vol 121 (09) ◽

pp. 1018-1025 ◽

Cited By ~ 3

Author(s):

Megan L. Lloyd ◽

Eva Malacova ◽

Ben Hartmann ◽

Karen Simmer

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Gestational Age ◽

Growth Velocity ◽

Neonatal Intensive Care ◽

Clinical Audit ◽

Donor Human Milk ◽

Weight Growth ◽

Significant Difference ◽

Mother’S Own Milk

AbstractPreterm infants whose mothers are unable to produce sufficient breast milk are increasingly being supplemented with pasteurised donor human milk (PDHM) instead of commercial preterm infant formula. Concerns have been raised that this practice can result in reduced growth. This retrospective clinical audit collected data from the medical records of a cohort of preterm infants (≤30 weeks gestational age) receiving either ≥28 d of PDHM (n 53) or ≥28 d of their mother’s own milk (MOM, n 43) with standard fortification supplied to both groups during admission. Weight growth velocity was assessed from regained birth weight to 34+1 weeks’ postmenstrual age (PMA); and weight, length and head circumference were compared at discharge and 12 months (corrected age). At 34+1 weeks’ PMA, the weight growth velocity (g/kg per d) was significantly lower in the PDHM group (15·4 g/kg per d, 95 % CI 14·6, 16·1) compared with the MOM group (16·9 g/kg per d, 95 % CI 16·1, 17·7, P=0·007). However, the increase was still within clinically acceptable limits (>15 g/kg per d) and no significant difference was observed in the weight between the two groups. There was no significant difference in weight between the groups at discharge or at the 12-month corrected gestational age review. Although we demonstrated a significant reduction in the weight growth velocity of preterm infants receiving PDHM at 34 weeks’ PMA, this difference is not present at discharge, suggesting that the growth deficit is reduced by supplementation before discharge.

Download Full-text

Effects of an exclusive human-milk diet in preterm neonates on early vascular aging risk factors (NEOVASC): study protocol for a multicentric, prospective, randomized, controlled, open, and parallel group clinical trial

Trials ◽

10.1186/s13063-021-05445-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wolfgang Mitterer ◽

Christoph Binder ◽

Anya Blassnig-Ezeh ◽

Lorenz Auer-Hackenberg ◽

Angelika Berger ◽

...

Keyword(s):

Risk Factors ◽

Clinical Trial ◽

Cardiovascular Risk ◽

Human Milk ◽

Preterm Infants ◽

Bovine Milk ◽

Control Group ◽

Milk Diet ◽

Randomized Controlled ◽

Parallel Group

Abstract Background Preterm birth accounts for approximately 11% of all livebirths globally. Due to improvements in perinatal care, more than 95% of these infants now survive into adulthood. Research has indicated a robust association between prematurity and increased cardiovascular risk factors and cardiovascular mortality. While the innate adverse effects of prematurity on these outcomes have been demonstrated, therapeutic strategies on the mitigation of these concerning developments are lacking. The primary objective of the NEOVASC clinical trial is therefore to investigate whether the administration of a prolonged exclusive human-milk diet in preterm infants is capable of alleviating the harmful effects of preterm birth on the early development of cardiovascular risk factors. Methods The NEOVASC study is a multicentric, prospective, randomized, controlled, open, and parallel group clinical trial conducted in four Austrian tertiary neonatal care facilities. The purpose of the present trial is to investigate the effects of a prolonged exclusive human-milk-diet devoid of bovine-milk-based food components on cardiovascular and metabolic risk factors at 1, 2, and 5 years of corrected age. Primary outcomes include assessments of fasting blood glucose levels, blood pressure levels, and the distensibility of the descending aorta using validated echocardiographic protocols at 5 years of corrected age. The test group, which consists of 200 preterm infants, will therefore be compared to a control group of 100 term-born infants and a historical control group recruited previously. Discussion Given the emerging implications of an increased cardiovascular risk profile in the potentially growing population of preterm infants, further research on the mitigation of long-term morbidities in formerly preterm infants is urgently warranted. Further optimizing preterm infants’ nutrition by removing bovine-milk-based food components may therefore be an interesting approach worth pursuing. Trial registration ClinicalTrials.govNCT04413994. Registered on 4 June 2020.

Download Full-text

A Retrospective Analysis of the Effects of an Exclusively Human Milk Protein Diet on Neonatal Feeding Tolerance

American Journal of Perinatology ◽

10.1055/s-0040-1721374 ◽

2020 ◽

Author(s):

Jessica Wickland ◽

Christine Wade ◽

Becky Micetic ◽

Keith Meredith ◽

Gregory Martin

Keyword(s):

Birth Weight ◽

Human Milk ◽

Milk Protein ◽

Very Low Birth Weight ◽

Bovine Milk ◽

Milk Diet ◽

Vlbw Infants ◽

Key Points ◽

Human Milk Protein ◽

Feeding Tolerance

Objective This study was aimed to evaluate the effect of human milk protein fortifier (HMPF) versus bovine milk protein fortifier (BMPF) on feeding tolerance defined as the time to reach full feeds and necrotizing enterocolitis (NEC) in premature very low birth weight (VLBW) infants. Study Design A retrospective review using the BabySteps Database included 493 infants born ≤33 weeks of gestational age and ≤1,250 g (g) birth weight. A total of 218 infants fed a human milk diet (HMD) with BMPF were compared with 275 infants fed an HMD with HMPF. Results Full feeds were reached significantly sooner in the HMPF group (median: 14 vs. 16 days, p = 0.04). Weight at full feeds was significantly lower in the HMPF group (1,060 vs. 1110 g, p = 0.03). Conclusion Using HMPF to provide an exclusively HMD allowed VLBW infants to achieve full feeds sooner, but did not affect rate of NEC compared with using a BMPF with an HMD. Key Points

Download Full-text

High-Temperature Short-Time and Holder Pasteurization of Donor Milk: Impact on Milk Composition

Life ◽

10.3390/life11020114 ◽

2021 ◽

Vol 11 (2) ◽

pp. 114

Author(s):

Diana Escuder-Vieco ◽

Juan M. Rodríguez ◽

Irene Espinosa-Martos ◽

Nieves Corzo ◽

Antonia Montilla ◽

...

Keyword(s):

High Temperature ◽

Human Milk ◽

Milk Composition ◽

Donor Human Milk ◽

High Temperature Short Time ◽

Lactose Concentration ◽

C 30 ◽

Milk Banks ◽

Short Time

Holder pasteurization (HoP; 62.5 °C, 30 min) is commonly used to ensure the microbiological safety of donor human milk (DHM) but diminishes its nutritional properties. A high-temperature short-time (HTST) system was designed as an alternative for human milk banks. The objective of this study was to evaluate the effect of this HTST system on different nutrients and the bile salt stimulated lipase (BSSL) activity of DHM. DHM was processed in the HTST system and by standard HoP. Macronutrients were measured with a mid-infrared analyzer. Lactose, glucose, myo-inositol, vitamins and lipids were assayed using chromatographic techniques. BSSL activity was determined using a kit. The duration of HTST treatment had a greater influence on the nutrient composition of DHM than did the tested temperature. The lactose concentration and the percentage of phospholipids and PUFAs were higher in HTST-treated than in raw DHM, while the fat concentration and the percentage of monoacylglycerides and SFAs were lower. Other nutrients did not change after HTST processing. The retained BSSL activity was higher after short HTST treatment than that following HoP. Overall, HTST treatment resulted in better preservation of the nutritional quality of DHM than HoP because relevant thermosensitive components (phospholipids, PUFAs, and BSSL) were less affected.

Download Full-text