PC2029: Implementing an Exclusive Human Milk Diet for Preterm Infants: Real-world Experience in Diverse Nicus

Purpose/Objectives: Despite evidence from clinical trials supporting the benefits of an exclusive human milk diet (EHMD) for very low birth weight (VLBW) preterm infants in the NICU, many barriers prevent its implementation. These include limited health economic outcome data and lack of standardized feeding guidelines. We present real-world EHMD data from seven diverse NICUs that may aid in the development of EHMD programs at other institutions.

Design/Methods: NICU leaders from seven US hospitals—varying in size, geographic setting, patient population, and funding models—shared their experiences implementing and sustaining an EHMD during a virtual expert roundtable in October 2020. Clinical outcomes data for each hospital were obtained either from VON (Vermont Oxford Network) or the institution’s NICU database. Necrotizing enterocolitis (NEC) rates and cost avoidance post-EHMD implementation were reported by 5 of the 7 institutions. Cost-avoidance calculations were based on published estimates for daily bed cost, total parenteral nutrition, late-onset sepsis, severe retinopathy of prematurity, bronchopulmonary dysplasia, and medical or surgical NEC. Prolacta Bioscience provided financial support for the roundtable, but representatives of the company were not present at the meeting and had no role in determining the content of this abstract.

Results: NICU characteristics and EHMD implementation parameters are summarized in Table 1. The 7 institutions varied by center type, level of care, and average annual admissions. Feeding volumes at initiation of fortification, fortification goals, and criteria for transitioning infants off the EHMD were similar; however, the maximum birth weight for EHMD administration ranged 1000 g–1500 g among participating NICUs. Of the 5 institutions reporting NEC data, 1 reported no change in total (medical + surgical) NEC rate post-EHMD implementation, while the other 4 reported reductions ranging 19%–100%. All 5 institutions reported reductions in surgical NEC, ranging 66%–100%. When factoring in length of stay and EHMD costs, an annualized cost-avoidance, ranging $515,113–$3,369,515, was reported by all 5 institutions (Figure 1).

Conclusion/Discussion: While not a replacement for multicenter, prospective, real-world analyses, our collaborative data fill gaps in evidence-based medicine for NICU leaders and provide support for implementing an EHMD for very preterm infants. Although there is no universal EHMD protocol, feeding practices were similar across institutions. Variations in the EHMD inclusion criteria reported here are likely due to local funding constraints. NEC is the major driver of per-patient NICU costs; thus, a reduction in NEC is a good benchmark for EHMD efficacy that makes a persuasive argument for funding. Improvements in complication rates and cost avoidance post-EHMD implementation at all institutions, despite differences in size and feeding protocols, demonstrate the value of this approach to nutritional support in a very vulnerable patient population. Our results also highlight the need for further systematic research on EHMD implementation.