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[Evaluation of human milk feeding in hospitalized very low and extremely low birth weight infants]
1Department of Pediatrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China.
Insights
Exclusive mother's own milk (MOM) feeding is low for hospitalized premature infants, particularly in the first week. Donor human milk (DHM) is more common, but MOM intake increases over time. Both MOM percentage and dose effectively measure human milk (HM) feeding.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Infant Feeding Practices
Background:
- Human milk (HM) is crucial for very low and extremely low birth weight (VLBW/ELBW) infants.
- Understanding HM feeding patterns in neonatal intensive care units (NICUs) is essential for optimizing infant nutrition.
- Current feeding strategies for VLBW/ELBW infants require investigation.
Purpose of the Study:
- To investigate the current status of human milk (HM) feeding in hospitalized very low and extremely low birth weight infants.
- To analyze feeding strategies including exclusive mother's own milk (MOM), donor human milk (DHM), and mixed feeding.
- To quantitatively evaluate HM feeding using percentage and dosage metrics.
Main Methods:
- Retrospective study of 601 VLBW/ELBW infants admitted to NICU from January 2016 to December 2018.
- Infants categorized into exclusive MOM, DHM, or mixed feeding groups.
- Statistical analysis (ANOVA, Kruskal-Wallis, Chi-square, Fisher exact, Kappa, McNemar tests) used for comparisons.
Main Results:
- Only 1.3% of infants were exclusively fed MOM; 90.2% received DHM, and 8.5% had mixed feeding.
- Percentage of enteral feedings with MOM significantly increased from 73.6% in days 1-7 to 99.3% in days 15-28.
- Average weight-adjusted daily MOM dose also significantly increased over hospitalization stages and varied by feeding group.
Conclusions:
- Exclusive mother's own milk (MOM) feeding rates are low, especially within the first week of hospitalization.
- Donor human milk (DHM) is a common alternative or supplement.
- The percentage of total enteral feedings with MOM and the average weight-adjusted daily dose of MOM are reliable quantitative indicators of HM feeding during hospitalization.
Abstract:
Objective: To investigate the current situation of human milk (HM) feeding in hospitalized very low and extremely low birth weight infants. Methods: The study retrospectively extracted the data of 601 infants with birth weight <1 500 g, and admitted within 24 hours after birth to the Neonatal Intensive Care Unit of Nanjing Maternity and Child Health Care Hospital from January 2016 to December 2018. The infants were grouped into exclusive mother's-own-milk (MOM) group, donor human milk (DHM) group (partial or none MOM), and mixed (HM and formula) feeding group according to the feeding strategy. Qualitative and quantitative variables in the three groups were compared with One-way ANOVA, Kruskal-Wallis test, Chi-square test or Fisher exact test. Kappa and McNemar test were used for consistency testing. Results: Among the 601 infants (309 boys and 292 girls), 6 (1.0%) infants had never been fed with MOM. The gestational age and birth weight were (29.3±1.9) weeks and 1 260(1 115, 1 400) g in 601 infants. A total of 8 (1.3%) infants were grouped into MOM group, 542 (90.2%) were grouped into DHM group, and 51 (8.5%) were grouped into mixed feeding group. The percentage of enteral feedings with MOM in the stage of hospitalization 1-7 d, 8-14 d and 15-28 d were 73.6% (42.9%, 86.7%), 97.5% (78.6%, 100.0%) and 99.3% (93.0%, 100.0%), respectively (H=414.95, P<0.01), and the pairwise comparison suggested that the stage of hospitalization 1-7 d was the lowest (adjusted both P<0.05). The average weight adjusted daily dose of MOM were 9.7 (4.3, 18.2), 59.1 (26.5, 93.5) and 116.0 (60.3, 142.6) ml/(kg·d) in the stage of hospitalization 1-7 d, 8-14 d and 15-28 d, respectively (H=759.75, P<0.01), and the pairwise comparison suggested that the stage of hospitalization 1-7 d was the lowest (adjusted both P<0.05). The weight adjusted daily dose of MOM in exclusive MOM group, DHM and Mixed feeding group were 95.2 (40.0, 117.2), 82.9(53.6, 103.1) and 55.7 (16.6, 97.5) ml/(kg·d), respectively (H=10.78, P=0.005).Additionally, the percentage and weight adjusted daily dose of MOM showed a general consistency of 0.703 (P>0.05, Kappa=0.408). Conclusions: The rate of exclusive MOM feeding is low, especially during the first 7 days of hospitalization. The percentage of total enteral feedings with MOM and the average weight adjusted daily dose of MOM can well evaluate the situation of HM feeding during hospitalization quantitively.
