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Supplemental Feedings for High-Risk Preterm Infants.

Supplemental Feedings for High-Risk Preterm Infants To the Editor The literature shows that the use of a predominately human milk diet (≥98%) in very low-birth-weight infants supports appropriate growth and development, decreases rates of necrotizing enterocolitis (NEC), decreases overall patient care costs, allows for earlier discharge, reduces patient risk of readmittance, and increases human milk consumption postdischarge.1-4 In their article, Corpeleijn et al5 conclude that feeding premature infants a diet of pasteurized donor milk during the first few days of life had no significant effect on preventing adverse health events. When considering how this study will affect clinical practice, we would like to encourage health care professionals to pay close attention to the following aspects: participant characteristics, duration of study, dose of donor milk or formula, and high rates of NEC observed. Regarding participant characteristics, infants at highest risk for developing complications were excluded from the study, and these infants may be the ones to benefit most from an exclusive human milk diet. The 10-day duration of the intervention is too short to assess effect on NEC rates. Large studies have shown that for very low-birth-weight babies, NEC most commonly presents much later than the first 10 days of life.2 Colaizy et al1 extended their analysis out to 36 weeks postmenstrual age to simulate the highest risk period for NEC. Sullivan et al3 used either the entirety of the hospital stay or a minimum observation period of 13 weeks to accurately assess outcomes stemming from diet differences. In both treatment groups, the participants received approximately 90% of their diet as mother’s own milk, which minimizes the effect of the assigned treatment diet on NEC outcomes. Also, the use of cow milk protein human milk fortifier mitigates the protective effect of donor milk.4 Finally, the incidence of NEC was approximately 9% in both treatment groups, indicating that perhaps something other than diet was involved in the development of NEC. Studies have shown that when an infant receives an exclusive human milk diet, NEC rates range from 1.3% to 7%.1-3 These limitations are significant and severely restrict any conclusions that can be drawn about the safety and efficacy of donor human milk in very low-birth-weight infants. These conclusions only apply when approximately 90% of the infant’s diet is mother’s own milk, when the intervention is administered for 10 days, and when the most fragile infants are not considered in the study.