title: Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet.
abstract: OBJECTIVE
  Human milk is the best form of nutrition for preterm infants and has been associated with a lower incidence of necrotizing enterocolitis (NEC). Infants that develop NEC have a higher incidence of feeding intolerance and longer hospitalizations. The combination of a donor milk bank and donor milk-derived fortifier has changed feeding practices in neonatal intensive care units (NICU). The purpose of this study is to assess the benefits and cost of an exclusive human milk (EHM) diet in very low birth weight (VLBW) infants in a community level III NICU.
  
  
  METHODS
  This is a retrospective study including preterm infants ⩽28 weeks and/or VLBW (⩽1500 g) who were enrolled from March 2009 until March 2014. Infants were grouped as follows: group H (entirely human milk based, born March 2012 to 2014), group B (bovine-based fortifier and maternal milk, born March 2009 to 2012), group M (mixed combination of maternal milk, bovine-based fortifier and formula, born March 2009 to 2012) and group F (formula fed infants, born March 2009 to 2012). Baseline characteristics among the four groups were similar.
  
  
  RESULTS
  The study included 293 infants between gestational ages 23 to 34 weeks and birth weights between 490 and 1700 g. Feeding intolerance occurred less often (P<0.0001), number of days to full feeds was lower (P<0.001), incidence of NEC was lower (P<0.011), and total hospitalization costs were lower by up to $106,968 per infant (P<0.004) in those fed an EHM diet compared with the other groups. Average weight gain per day was similar among the four groups (18.5 to 20.6 g per day).
  
  
  CONCLUSIONS
  Implementing an EHM diet in our VLBW infants has led to a significant decrease in the incidence of NEC. Other benefits of this diet include: decreased feeding intolerance, shorter time to full feeds, shorter length of stay, and lower hospital and physician charges for extremely premature and VLBW infants.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Assad
authors.affiliation: Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA.|Pediatrix Medical Group of Maryland, The Herman & Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Elliott
authors.affiliation: Division of Neonatology, Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Abraham
mesh_terms: D000818:Animals; D001724:Birth Weight; D002417:Cattle; D020345:Enterocolitis, Necrotizing / Q000178:diet therapy* / Q000191:economics* / Q000517:prevention & control; D005260:Female; D005527:Food, Fortified; D005865:Gestational Age; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D016014:Linear Models; D008297:Male; D008892:Milk; D017784:Milk Banks / Q000191:economics; D008895:Milk, Human; D012189:Retrospective Studies; D015430:Weight Gain