Human Milk is the Feeding Strategy to Prevent Necr

Authors: Richard J Schanler

Publish Date: 2014/09/24

Volume: 2, Issue: 4, Pages: 264-268

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Abstract

The use of human milk in the neonatal intensive care unit clearly has short and longterm beneficial effects but its role in the prevention of necrotizing enterocolitis NEC cannot be understated Immaturity of the intestinal tract barrier function and mucosal defense contributes to NEC Human milk feeding enhances maturity of the intestinal tract barrier functions and mucosal defenses by providing components such as immunoglobulin A lactoferrin lysozyme oligosaccharides epidermal growth factor acetylhydrolase erythropoietin arginine and glutamine and polyunsaturated fatty acids and the ability to promote a commensal intestinal microfloraThe challenge to meet the nutritional goals of the extremely low birth weight ELBW infant while attempting to avoid serious complications and adverse outcomes such as necrotizing enterocolitis NEC can be overcome with human milk 1 2 Such a diet meets nutritional needs as well as provides health benefits to the recipient Why a human milk diet particularly benefits the health of the ELBW infant will be reviewedIt has been demonstrated that a mother’s own milk MOM diet is beneficial for ELBW infants because it is associated with prevention of late onset sepsis LOS NEC and urinary tract infection 3 4 5 6 7 That the host protection extends beyond the NICU stay is evidenced by fewer readmissions to the hospital for respiratory illness through almost 3 years 8 It is estimated that there is a 5  decrease in the odds of being rehospitalized for any infectious disease for every 10 mL/kg/day human milk consumed in the NICU 8There is a 50  reduction in the rate of NEC and/or LOS and a shortened length of hospital stay among the ELBW infants receiving MOM at an average daily dose of more than 50 mL/kg compared to MOM + formula or formula alone 3 That observation suggested that the dose of MOM more than approximately 50 mL/kg/day was important to detect a beneficial health effect in ELBW infants 3The concept of a “dosedependent” protective effect of human milk has been reported elsewhere ELBW infants n = 202 receiving more than 50  MOM in the first 14 days after birth had an 83  reduction in the subsequent development of NEC compared to those receiving a diet of less than 50  MOM 9 A daily intake of more than 50 mL/kg for 4 weeks also is associated with a lower rate of neonatal sepsis 10 The dosedependent benefit should not be considered maximized at 50  intake In a large retrospective analysis of 1272 infants the likelihood of NEC or death after 14 days was decreased by a factor of 083 for each 10  increase in the proportion of total intake as human milk suggesting the importance of dose and the predominance of a human milk diet 11Early initiation of human milk is advocated and practiced in the NICU A Dutch study of 349 infants observed that the intakes of MOM 50  during the first 5 days after birth was associated subsequently with a lower incidence of NEC sepsis and/or death during the first 60 days after birth 6 An even stronger prediction model was observed if the intake of MOM was more than 50  during days 6–10 after birth 6 These studies suggest that in the ELBW population the important early protective effects of a human milk diet are longlastingThere are effects of human milk on the gastrointestinal tract of ELBW infants that account for the better acceptance of this milk when compared to formula There are significantly fewer gastric residuals and less time feedings were withheld in infants receiving MOM versus formula 3 Milestones such as achievement of full enteral feeding and length of hospital stay are significantly shortened with the feeding of MOM These milestones are achieved in nearly twice as many days when the percentile of human milk intake was less than 20  as compared to more than 80  12Human milk feeding in ELBW infants also has been shown to protect against retinopathy of prematurity and its most severe form retinal detachment 13 14 These observations support a role of human milk as an antioxidant as well as containing factors that affect angiogenesis

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