title: Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products.
abstract: BACKGROUND
  Provision of human milk has important implications for the health and outcomes of extremely preterm (EP) infants. This study evaluated the effects of an exclusive human milk diet on the health of EP infants during their stay in the neonatal intensive care unit.
  
  
  METHODS
  EP infants <1,250 g birth weight received a diet consisting of either human milk fortified with a human milk protein-based fortifier (HM) (n=167) or a diet containing variable amounts of milk containing cow milk-based protein (CM) (n=93). Principal outcomes were mortality, necrotizing enterocolitis (NEC), growth, and duration of parenteral nutrition (PN).
  
  
  RESULTS
  Mortality (2% versus 8%, p=0.004) and NEC (5% versus 17%, p=0.002) differed significantly between the HM and CM groups, respectively. For every 10% increase in the volume of milk containing CM, the risk of sepsis increased by 17.9% (p<0.001). Growth rates were similar between groups. The duration of PN was 8 days less in the subgroup of infants receiving a diet containing <10% CM versus ≥10% CM (p<0.02).
  
  
  CONCLUSIONS
  An exclusive human milk diet, devoid of CM-containing products, was associated with lower mortality and morbidity in EP infants without compromising growth and should be considered as an approach to nutritional care of these infants.
authors.affiliation: 1 Children's Nutrition Research Center, U.S. Department of Agriculture, Agricultural Research Service; and Department of Pediatrics, Baylor College of Medicine , Houston, Texas.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Abrams
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schanler
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lee
authors.forename: David J
authors.initials: DJ
authors.lastname: Rechtman
mesh_terms: D000818:Animals; D001942:Breast Feeding / Q000379:methods; D002417:Cattle; D020345:Enterocolitis, Necrotizing / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D008894:Milk Proteins / Q000009:adverse effects*; D008895:Milk, Human; D010288:Parenteral Nutrition / Q000009:adverse effects* / Q000379:methods / Q000401:mortality
chemical_list: D008894:Milk Proteins