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The authors explore the impact of human milk (HM) on the frequency of incidence of necrotizing entercolitis (NEC) in very low birth weight (VLBW) infants. The mothers of VLBW infants often experience insufficient breast milk production to sustain their infants, which results in mixed formula and HM feedings. Additionally, medical complications frequently limit the volume of formula that can be given to infants with NEC. The research hypothesis was that high proportions (50% or greater) of HM enteral feeding within the first 14 days of life are protective against NEC. The research method was a prospective cohort study of VLBW infants who were grouped by the HM proportion of enteral feeding in the first 14 days. Of the 202 infants studied, two groups were established: <50% (low human milk, LHM, n=46) and >50% (high human milk, HHM, n=156). The outcome measure was the development of NEC (as indicated by Bell stage 2 or 3). Logistical regression was used to estimate the odds ratios (OR), potential confounding due to perinatal risk factors, and 95% confidence intervals (CI). NEC was confirmed in 5 out of 46 (or 10.6%) of the LHM group, compared to 5 out of 156 (3.2%) of the HHM group. The only perinatal factor associated with the risk of NEC was gestational age. After adjusting for gestational age, HHM was associated with a lower risk of NEC as follows: Odds ratios (OR) = 0.17 at 95% confidence intervals of 0.04 to 0.68, P =0.01. The authors concluded that enteral feeding that contained at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of VLBW infants acquiring NEC.

Sullivan, S., Schanler, R.J., Kim, J.H., Patel, J.H., Tawoger, R., Kiechi-Kohlendorfer, U., Chan, G.M., Blanco, C.L., Abrams, S., Cotton, C.M., Laroia, N., Ehrenkranz, R.A., Dudell, G., Cristofalo, E.A., Meier, P., Lee, M.L., Rechtman, D.J., and Lucas, A. (2010, April). An exclusively human milk-based diet is associated wih a lower rate of necrotizing entercolitis than a diet of human milk and bovien milk-based products. The Journal of Pediatrics, 156(4), 562-567e1. Retrieved http://www.sciencedirect.com / science/article/pii/S0022347609010853

The authors evaluated the health benefits to extremely premature infants when given exclusively human milk-based diet compared to a mixed diet of human milk and bovine milk-based products. Infants who were exclusively fed breast milk by their mothers were randomly assigned to one of three groups: HM 100, HM 40, and BOV. The infants in the HM 100 group and the HM 40 group were given pasteurized donor human milk-based human milk fortifier when the enteral intake was 100 mL/kg/d and 40 mL/kg/d respectively. Both groups received pasteurized donor milk if no mother's milk was available. The BOV group received bovine milk-based human milk fortifier when enteral intake was 100 mL/kg/d and preterm formula if no mother's milk was available. The research outcomes were duration of paternal nutrition, growth, and morbidity. A total of 207 infants were included in the research, all of whom had similar baseline demographic variables, durations of parental nutrition, growth, and rates of late-onset sepsis. The infants in the groups who received a diet that consisted exclusively of human milk had significantly lower rates of necrotizing enterocolitis (NEC) significant at P = .02, and NEC that required surgical intervention, significant at P = .007. The authors concluded that extremely premature infants would benefit from an exclusively human milk-based diet, benefits that were specifically manifested by significantly lower rates of NEC and surgical NEC when compared to the infants who received a diet of mother's milk and bovine milk-based products.