title: Beyond Necrotizing Enterocolitis Prevention: Improving Outcomes with an Exclusive Human Milk-Based Diet.
abstract: OBJECTIVE
  The aim of this study was to compare outcomes of infants pre and post initiation of a feeding protocol providing an exclusive human milk-based diet (HUM).
  
  
  METHODS
  In a multicenter retrospective cohort study, infants with a birth weight <1,250 g who received a bovine-based diet (BOV) of mother's own milk fortified with bovine fortifier and/or preterm formula were compared to infants who received a newly introduced HUM feeding protocol. Infants were excluded if they had major congenital anomalies or died in the first 12 hours of life. Data were collected 2-3 years prior to and after introduction of an exclusive HUM diet. Primary outcomes were necrotizing enterocolitis (NEC) and mortality. Secondary outcomes included late-onset sepsis, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD).
  
  
  RESULTS
  A total of 1,587 infants were included from four centers in Texas, Illinois, Florida, and California. There were no differences in baseline demographics or growth of infants. The HUM group had significantly lower incidence of proven NEC (16.7% versus 6.9%, p < 0.00001), mortality (17.2% versus 13.6%, p = 0.04), late-onset sepsis (30.3% versus 19.0%, p < 0.00001), ROP (9% versus 5.2%, p = 0.003), and BPD (56.3% versus 47.7%, p = 0.0015) compared with the BOV group.
  
  
  CONCLUSIONS
  Extremely premature infants who received an exclusive HUM diet had a significantly lower incidence of NEC and mortality. The HUM group also had a reduction in late-onset sepsis, BPD, and ROP. This multicenter study further emphasizes the many benefits of an exclusive HUM diet, and demonstrates multiple improved outcomes after implementation of such a feeding protocol.
authors.affiliation: 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Hair
authors.affiliation: 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Peluso
authors.affiliation: 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas.
authors.forename: Keli M
authors.initials: KM
authors.lastname: Hawthorne
authors.affiliation: 2 Department of Neonatology, Winnie Palmer Hospital for Women and Babies , Orlando, Florida.
authors.forename: Jose
authors.initials: J
authors.lastname: Perez
authors.affiliation: 2 Department of Neonatology, Winnie Palmer Hospital for Women and Babies , Orlando, Florida.
authors.forename: Denise P
authors.initials: DP
authors.lastname: Smith
authors.affiliation: 3 Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Janine Y
authors.initials: JY
authors.lastname: Khan
authors.affiliation: 4 Department of Clinical Nutrition Services, Northwestern Memorial Hospital , Chicago, Illinois.
authors.forename: Andrea
authors.initials: A
authors.lastname: O'Donnell
authors.affiliation: 5 Department of Neonatology, Good Samaritan Hospital , San Jose, California.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powers
authors.affiliation: 6 Prolacta Bioscience , Industry, California.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Lee
authors.affiliation: 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Abrams
mesh_terms: D000328:Adult; D000818:Animals; D001724:Birth Weight; D001942:Breast Feeding / Q000706:statistics & numerical data; D002417:Cattle; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D008895:Milk, Human; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology