Reduced Necrotizing Enterocolitis after an Initiative to Promote Breastfeeding and Early Human Milk Administration

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Microbiome Research

Background:

• Necrotizing enterocolitis (NEC) poses a significant risk to premature infants (PI).
• Establishing protective intestinal bacteria early is crucial for preventing NEC.
• Human milk (HM) and probiotics are investigated for their potential to foster a healthy gut microbiome.

Purpose of the Study:

• To reduce the incidence of NEC in premature infants.
• To promote the establishment of protective intestinal bacteria through early HM and probiotic administration.

Main Methods:

• A multidisciplinary initiative focused on supporting breastfeeding (BF) and providing early donor human milk (DHM) and probiotics to PI.
• Process improvements in milk preparation, storage, and fortification were implemented.
• Feeding practices and NEC incidence were monitored in PI admitted between 2006 and 2015.

Main Results:

• Increased rates of HM (91.5% to 96.1%) and DHM (17.7% to 71.9%) feeding were observed.
• Early feeding initiation (day one) increased (23.9% to 44.6%), while preterm formula (PF) use decreased (31.2% to 10.3%).
• The NEC rate dramatically declined from 4.1% to 0.4%.

Conclusions:

• Early exclusive HM feeding and avoidance of PF, alongside probiotics and milk hygiene, may decrease NEC in PI.
• Perinatal antibiotic exposure and late bovine fortifier introduction did not appear detrimental in this context.
• Optimized milk handling and early nutritional interventions are key to reducing NEC incidence.