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Proactive Use of a Human Milk Fat Modular in the Neonatal Intensive Care Unit: A Standardized Feeding Protocol
Amanda Salley1, Martin L Lee2,3
1Hinsdale Hospital, UChicago Medicine AdventHealth Hinsdale Hospital, Hinsdale, IL 60521, USA.
Insights
Proactively adding a human milk fat modular to the diet of very low birth weight (VLBW) infants improved their growth and reduced malnutrition. This feeding protocol change also decreased the need for costly fortifiers, offering significant cost savings.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Clinical Quality Improvement
Background:
- Exclusive human milk diet (EHMD) and standardized feeding protocols are crucial for very low birth weight (VLBW) infants.
- Previous protocols used human milk fat modular reactively, prompting a review for growth and cost optimization.
- Quality improvement initiatives identified opportunities to enhance VLBW infant feeding guidelines.
Purpose of the Study:
- To evaluate the impact of a revised feeding protocol on VLBW infant growth and nutritional support.
- To assess changes in the utilization of human milk fat modular and other fortifiers.
- To determine the cost-effectiveness of the updated feeding strategy.
Main Methods:
- A pre-post cohort study comparing feeding protocols in VLBW infants.
- Implementation of a revised protocol in October 2021, proactively adding human milk fat modular (Prolact CR) post-parenteral nutrition.
- Data collection on modular use, fortifier requirements, infant growth, and associated costs.
Main Results:
- The revised protocol saw a significant decrease in the need for human milk +8 fortifier (43% to 14%).
- Average cost savings of approximately $2967.78 per infant were achieved.
- Overall infant growth improved, with a reduction in severe malnutrition from 3.3% to 2.7% and moderate malnutrition from 37% to 8%.
Conclusions:
- Proactive use of human milk fat modular in standardized protocols enhances VLBW infant growth and lowers malnutrition rates.
- This approach reduces reliance on more expensive caloric fortifiers.
- The revised feeding protocol offers significant clinical and economic benefits for VLBW infants.
Abstract:
An exclusive human milk diet (EHMD) and standardized feeding protocols are two critical methods for safely feeding very low birth weight (VLBW) infants. Our institution initiated a standardized feeding protocol for all VLBW infants in 2018. In this protocol, a human milk fat modular was used only reactively when an infant had poor weight gain, fluid restriction, or hypoglycemia. As part of our NICU quality improvement program, internal utilization review data revealed a potential opportunity to improve growth and reduce costs. While maintaining the EHMD, a simple feeding guideline process change could provide cost savings without sacrificing caloric density or growth. We examined this process change in pre-post cohorts of VLBW infants.
Methods:
Our revised feeding protocol, established in October 2021, called for a human milk fat modular (Prolact CR) to be added to all infant feeding when parenteral nutrition (PN) and lipids were discontinued. The human milk fat modular concentration is 4 mL per 100 mL feed, providing approximately an additional 2 kcal/oz. We tracked data to compare (1) the use of the human milk fat modular, (2) the use of the human milk +8 fortifier, (3) overall growth before and after feeding protocol changes, and (4) cost differences between protocols.
Results:
Thirty-six VLBW infants were followed prospectively upon the introduction of the revised feeding protocol. In the revised era, the need for human milk +8 fortifier decreased from 43% to 14%. The decrease in the cost of a more costly fortifier provided a cost savings of USD 2967.78 on average per infant. Overall growth improved from birth to discharge, with severe malnutrition declining from 3.3% to 2.7% and moderate malnutrition declining from 37% to 8%.
Conclusions:
With the proactive use of a human milk fat modular in a standardized feeding protocol, our VLBW infants showed improved growth, lower malnutrition rates, and decreased use of higher caloric fortifiers.
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