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Updated: Jan 20, 2026
A Novel Human Epithelial Enteroid Model of Necrotizing Enterocolitis
Published on: April 10, 2019
Necrotizing Enterocolitis Reduction Using an Exclusive Human-Milk Diet and Probiotic Supplementation in Infants With
Ray Sato1,2, Solyvattey Malai3, Behzad Razmjouy4
1Mednax National Medical Group, Tacoma, WA, USA.
Insights
Implementing an exclusive human milk diet and probiotics significantly reduced necrotizing enterocolitis (NEC) in premature infants. This quality improvement initiative improved NEC rates without impacting infant growth.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Quality Improvement Science
Background:
- Necrotizing enterocolitis (NEC) is a significant complication in premature infants.
- This study evaluated interventions to reduce NEC in premature infants at intermediate risk.
Purpose of the Study:
- To compare clinical outcomes in premature infants before and after implementing a quality improvement program aimed at reducing NEC.
- To assess the impact of an exclusive human milk diet and probiotic supplementation on NEC incidence and infant growth.
Main Methods:
- Retrospective single-center chart review of infants (1000-1499 g birth weight) over six years.
- Infants were divided into pre-intervention and post-intervention epochs based on the introduction of human milk-derived fortifier and probiotic supplements.
- Exclusion criteria included major congenital anomalies.
Main Results:
- The post-intervention group (n=265) showed a significantly lower incidence of NEC (1.1%) compared to the pre-intervention group (n=140, 5.2%; P=0.046).
- Somatic growth rates were comparable between the two study epochs.
Conclusions:
- Quality improvement initiatives incorporating an exclusive human milk diet and daily probiotic supplementation are associated with decreased NEC incidence in premature infants.
- The implemented NEC reduction bundle did not adversely affect infant growth outcomes.
Background:
Necrotizing enterocolitis (NEC) is a major complication confronting clinicians caring for premature infants. This investigation compares clinical outcomes before and after quality improvement-program interventions in a population of premature infants at intermediate risk for NEC.
Methods:
This study is a retrospective single-center chart review of infants admitted with a birth weight of 1000-1499 g, excluding major congenital anomalies, over a 6-year period, beginning with implementation of a donor breast-milk program when mother's own milk was not available. Infants were separated into 2 epochs, before (July 2012-December 2013) and after (April 2014-June 2018) introduction of human milk-derived fortifier (Prolacta) and a daily probiotic (FloraBABY) supplement.
Results:
Comparing 140 preintervention infants with 265 postintervention infants, NEC was significantly lower in the postintervention group: 5.2% vs 1.1% (P = 0.046). Somatic growth was similar in both epochs.
Conclusions:
Quality-improvement initiatives utilizing an exclusive human-milk diet and daily probiotic supplementation were associated with a decreased incidence of NEC in infants with a birth weight of 1000-1499 g. Implementation of the NEC reduction bundle did not affect infant growth.
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