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The impact of exclusive human milk diet on short-term growth of very preterm infants

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objectives

The impact of exclusive human milk diet (EHMD) on postnatal growth remains controversial. This study aims to investigate the association between EHMD and short-term growth.

Methods

This multicenter retrospective study aims to compare growth between the EHMD and non-EHMD groups among infants <32 weeks of gestation. Primary outcomes include weight, length, and head circumference growth trajectories between birth and 34 weeks postmenstrual age. Sensitivity and subgroup analyses were performed.

Results

An EHMD was independently associated with poorer length growth, especially in infants born at ≥28 weeks’ gestation or those exposed to hypertensive disorders of pregnancy. While initiating fortification at <26 kcal/oz on an EHMD showed inferior growth, initiating fortification at ≥26 kcal/oz was associated with improved weight growth, and similar length and head circumference growth when compared to the non-EHMD group.

Conclusions

An EHMD with initial fortification at ≥26 kcal/oz may be implemented to avoid bovine milk exposure while sustaining comparable growth.

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Fig. 1: Exclusive human milk diet (EHMD) use.
Fig. 2: Results of weighted multivariable mixed models showing mean differences (coefficients, in black dots) and 95% confidence intervals (whiskers) in trajectory percentiles between the non-EHMD (reference) and EHMD groups.

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Data availability

Deidentified individual participant data may be requested with a formal utilization plan, pending approval by the Institutional Review Board of Southern California Kaiser Permanente.

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Acknowledgements

The authors would like to thank Dr. Hung-Wen Yeh, PhD of Children’s Mercy Research Institute in Kansas City, MO, USA for his statistical consultation.

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Authors and Affiliations

  1. Southern California Permanente Medical Group, Pasadena, CA, USA

    Fu-Sheng Chou, Giulia M. Faison, Maria Fe B. Villosis & Karine Barseghyan

  2. Kaiser Permanente Riverside Medical Center, Riverside, CA, USA

    Fu-Sheng Chou, Cammie Nguyen & Giulia M. Faison

  3. Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA

    Fu-Sheng Chou, Lindsey R. Thompson, Maria Fe B. Villosis, Karine Barseghyan & Ashwini Lakshmanan

  4. Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, USA

    Jing Zhang

  5. Kaiser Permanente Panorama City Medical Center, Panorama City, CA, USA

    Maria Fe B. Villosis & Karine Barseghyan

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  1. Fu-Sheng Chou
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  8. Ashwini Lakshmanan
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Contributions

FC conceptualized and designed the study, supervised data collection, performed the initial analysis, interpreted data, and drafted the initial manuscript. JZ collected data, assisted in data analysis, and critically reviewed the manuscript. CN participated in study design, interpreted data, and critically reviewed the manuscript. GMF, LRT, MFBV, and KBD contributed to data interpretation and critically reviewed the manuscript for important intellectual content. GMF also provided language editing to the final manuscript. AL participated in study design, supervised data interpretation, and critically reviewed the manuscript.

Corresponding author

Correspondence to Fu-Sheng Chou.

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Competing interests

The authors declare no competing interests.

Ethics approval

This data-only study was approved by the Institutional Review Board of Southern California Kaiser Permanente, with an exemption from the requirement for informed consent.

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Chou, FS., Zhang, J., Nguyen, C. et al. The impact of exclusive human milk diet on short-term growth of very preterm infants. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01980-w

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