Team-Based Implementation of an Exclusive Human Milk Diet

Area of Science:

• Neonatal Medicine
• Pediatric Nutrition
• Clinical Practice Improvement

Background:

• Neonatal intensive care units (NICUs) face challenges with necrotizing enterocolitis (NEC) and feeding intolerance despite evidence-based care.
• The University of Virginia NICU, admitting 600-700 infants annually, identified NEC and feeding intolerance as persistent issues.

Purpose of the Study:

• To evaluate the impact of implementing an exclusive human milk diet (EHMD) for infants weighing 1250 g or less.
• Primary goals included reducing NEC, feeding intolerance, parenteral nutrition use, and late-onset sepsis.
• Secondary outcomes assessed were length of stay, bronchopulmonary dysplasia (BPD), and retinopathy of prematurity.

Main Methods:

• A multidisciplinary work group established systems for charging and documenting products associated with an EHMD.
• Outcomes of infants receiving an EHMD were compared to a historical control group of similar infants admitted prior to the EHMD's availability.

Main Results:

• Infants on an EHMD experienced significantly fewer evaluations for late-onset sepsis (P = .0027) and reduced incidence of BPD (P = .018).
• While not statistically significant, there was a reduction in surgical NEC cases (14.3% vs. 57% of total NEC cases).
• The EHMD strategy maintained desirable infant weight gain and met financial objectives.

Conclusions:

• Implementing an EHMD, supported by financial and documentation systems, can be a sustainable clinical practice improving NICU patient outcomes.
• Ongoing evaluation of clinical and financial data is crucial for refining EHMD practices.
• Further research into the anti-inflammatory effects of EHMD and its role in sepsis prevention is warranted, alongside exploring its use in larger infants (>1250 g).