Advertisement

Human Milk Feedings in the Neonatal Intensive Care Unit

  • Paula P. Meier
  • Aloka L. Patel
  • Harold R. Bigger
  • Yimin Chen
  • Tricia J. Johnson
  • Beverly Rossman
  • Janet L. Engstrom
Living reference work entry

Abstract

Human milk (HM) from the infant’s own mother reduces the risk of prematurity- and other NICU-acquired morbidities in a dose–response relationship, with higher doses of HM received during critical exposure periods in the NICU hospitalization providing the greatest risk reduction. This protection is provided through a unique array of nutritive, immunomodulatory, anti-inflammatory, anti-oxidant, gut-colonizing, growth-promoting, and epigenetic components that function synergistically to optimize infant health and reduce costs during and after the NICU hospitalization. This chapter reviews the clinical outcomes of HM feeding for premature and sick infants, describes the mechanisms by which this protection is provided, and depicts common clinical scenarios that compromise the caloric content in pumped HM that is fed in the NICU. Emphasis throughout is on integrating the underlying scientific principles with examples of evidence-based best practices for the use of HM in the NICU.

Keywords

Premature Infant Human Milk Neonatal Intensive Care Unit VLBW Infant Breast Pump 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

AGA

Appropriate for gestational age

CLD

Chronic lung disease

ELBW

Extremely low birthweight (<1,000 g)

HM

Human milk

HMF

Human milk fortifier

NEC

Necrotizing enterocolitis

NICU

Neonatal intensive care unit

PGF

Postnatal growth failure

PMA

Post menstrual age

ROP

Retinopathy of prematurity

USD

United States dollars

VLBW

Very low birthweight (<1,500 g)

cal/oz

Calories per ounce

g/L

Grams per liter

kCal/L

Kilocalories per liter

mLs

Milliliters

mL/Kg/D

Milliliters per kilogram per day

References

  1. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129:827–41.CrossRefGoogle Scholar
  2. Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: Does it make a difference? [see comment]. J Perinatol. 2006;26:614–21.CrossRefPubMedGoogle Scholar
  3. Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need. J Perinatol. 2009;29:489–92.CrossRefPubMedGoogle Scholar
  4. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013;60:49–74.PubMedCentralCrossRefPubMedGoogle Scholar
  5. Bartok CJ, Ventura AK. Mechanisms underlying the association between breastfeeding and obesity. Int J Pediatr Obes. 2009;4:196–204.CrossRefPubMedGoogle Scholar
  6. Belfort MB, Rifas-Shiman SL, Sullivan T, et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics. 2011;128:899–906.CrossRefGoogle Scholar
  7. Bigger HR, Fogg LJ, Patel AL, Johnson T, Engstrom JL, Meier PP. Quality indicators for human milk use in very low birthweight infants: are we measuring what we should be measuring? J Perinatol. 2014. doi:10.1038/jp.2014.s. [epub ahead of print].Google Scholar
  8. Caicedo RA, Schanler RJ, Li N, Neu J. The developing intestinal ecosystem: implications for the neonate. Pediatr Res. 2005;58:625–8.CrossRefPubMedGoogle Scholar
  9. Calder PC, Krauss-Etschmann S, de Jong EC, et al. Early nutrition and immunity - progress and perspectives. Br J Nutr. 2006;96:774–90.CrossRefPubMedGoogle Scholar
  10. Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA. Growth failure in the preterm infant: can we catch up? Semin Perinatol. 2003;27:302–10.CrossRefPubMedGoogle Scholar
  11. Dvorak B, Fituch CC, Williams CS, Hurst NM, Schanler RJ. Concentrations of epidermal growth factor and transforming growth factor-alpha in preterm milk. Adv Exp Med Biol. 2004;554:407–9.CrossRefPubMedGoogle Scholar
  12. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253–61.CrossRefPubMedGoogle Scholar
  13. ESPGHAN Committee on Nutrition, Agostoni C, Braegger C, et al. Breast-feeding: a commentary by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2009;49:112–25.CrossRefGoogle Scholar
  14. Friel J, Diehl-Jones B, Cockell K, et al. Evidence of oxidative stress in relation to feeding type during early life in premature infants. Pediatr Res. 2011;69:160–4.CrossRefPubMedGoogle Scholar
  15. Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med. 2003;157:66–71.CrossRefPubMedGoogle Scholar
  16. Furman L, Wilson-Costello D, Friedman H, Taylor HG, Minich N, Hack M. The effect of neonatal maternal milk feeding on the neurodevelopmental outcome of very low birth weight infants. J Dev Behav Pediatr. 2004;25:247–53.CrossRefPubMedGoogle Scholar
  17. Griffin TL, Meier PP, Bradford LP, Bigger HR, Engstrom JL. Mothers’ performing creamatocrit measures in the NICU: accuracy, reactions, and cost. J Obstet Gynecol Neonatal Nurs. 2000;29:249–57.CrossRefPubMedGoogle Scholar
  18. Higgins RD, Devaskar S, Hay Jr WW, et al. Executive summary of the workshop “nutritional challenges in the high risk infant”. J Pediatr. 2012;160:511–6.PubMedCentralCrossRefPubMedGoogle Scholar
  19. Howie PW, Houston MJ, Cook A, Smart L, McArdle T, McNeilly AS. How long should a breast feed last? Early Hum Dev. 1981;5:71–7.CrossRefPubMedGoogle Scholar
  20. Hurst N, Engebretson J, Mahoney JS. Providing mother’s own milk in the context of the NICU: a paradoxical experience. J Hum Lact. 2013;29:366–73.CrossRefPubMedGoogle Scholar
  21. Jensen RG. The lipids of human milk. Boca Raton: CRC Press; 1989.Google Scholar
  22. Jensen RG, editor. Handbook of milk composition. San Diego: Academic; 1995.Google Scholar
  23. Jeurink PV, van Bergenhenegouwen J, Jimenez E, et al. Human milk: a source of more life than we imagine. Benefic Microbes. 2013;4:17–30.CrossRefGoogle Scholar
  24. Johnson TJ, Patel AL, Jegier B, Engstrom JL, Meier J. The cost of morbidities in very low birth weight infants. J Pediatr. 2013;162:243–9.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Johnson TJ, Patel AL, Engstrom JL, Fogg LF, Jegier BJ, Bigger HR, Meier PP. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birthweight infants. Neonatology (in press).Google Scholar
  26. Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very low birth weight infants. Adv Nutr. 2014;5:207–12.PubMedCentralCrossRefPubMedGoogle Scholar
  27. Kent JC. How breastfeeding works. J Midwifery Womens Health. 2007;52:564–70.CrossRefPubMedGoogle Scholar
  28. Kverka M, Burianova J, Lodinova-Zadnikova R, Kocourkova I, Cinova J, Tuckova L, Tlaskalova-Hogenova H. Cytokine profiling in human colostrum and milk by protein array. Clin Chem. 2007;53:955–62.CrossRefPubMedGoogle Scholar
  29. Lemay DG, Ballard OA, Hughes MA, Morrow AL, Horseman ND, Nommsen-Rivers LA. RNA sequencing of the human milk fat layer transcriptome reveals distinct gene expression profiles at three stages of lactation. PLoS One. 2013;8:e67531.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Lonnerdal B. Nutritional and physiologic significance of human milk proteins. Am J Clin Nutr. 2003;77:1537S–43.PubMedGoogle Scholar
  31. Lonnerdal B. Bioactive proteins in human milk: mechanisms of action. J Pediatr. 2010;156(2 Suppl):S26–30.CrossRefPubMedGoogle Scholar
  32. Lucas A, Gibbs JA, Lyster RL, Baum JD. Creamatocrit: simple clinical technique for estimating fat concentration and energy value of human milk. Br Med J. 1978;1:1018–20.PubMedCentralCrossRefPubMedGoogle Scholar
  33. Maayan-Metzger A, Avivi S, Schushan-Eisen I, Kuint J. Human milk versus formula feeding among preterm infants: short-term outcomes. Am J Perinatol. 2012;29:121–6.CrossRefPubMedGoogle Scholar
  34. Mei J, Zhang Y, Wang T, Sangild PT, Xu RJ. Oral ingestion of colostrum alters intestinal transforming growth factor-beta receptor intensity in newborn pigs. Livest Sci. 2006;105:214–22.CrossRefGoogle Scholar
  35. Meier PP, Engstrom JL, Murtaugh MA, Vasan U, Meier WA, Schanler RJ. Mothers’ milk feedings in the neonatal intensive care unit: accuracy of the creamatocrit technique. J Perinatol. 2002;22:646–9.CrossRefPubMedGoogle Scholar
  36. Meier PP, Engstrom JL, Zuleger JL, et al. Accuracy of a user-friendly centrifuge for measuring creamatocrits on mothers’ milk in the clinical setting. Breastfeed Med. 2006;1:79–87.CrossRefPubMedGoogle Scholar
  37. Meier PP, Engstrom JL, Hurst NM, et al. A comparison of the efficiency, efficacy, comfort, and convenience of two hospital-grade electric breast pumps for mothers of very low birthweight infants. Breastfeed Med. 2008;3:141–50.CrossRefPubMedGoogle Scholar
  38. Meier PP, Engstrom JL. Preventing, diagnosing and managing slow weight gain in the human milk-fed very low birthweight infant. Sulla Nutrizione Con Latte Materno. 2010.Google Scholar
  39. Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns N. Improving the use of human milk during and after the NICU stay. Clin Perinatol. 2010;37:217–45.PubMedCentralCrossRefPubMedGoogle Scholar
  40. Meier PP, Engstrom JL, Janes JE, Jegier BJ, Loera F. Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol. 2012;32:103–10.PubMedCentralCrossRefPubMedGoogle Scholar
  41. Meier PP, Engstrom JL, Rossman B. Breastfeeding peer counselors as direct lactation care providers in the neonatal intensive care unit. J Hum Lact. 2013a;29:313–22.CrossRefPubMedGoogle Scholar
  42. Meier PP, Patel AL, Bigger HR, Rossman B, Engstrom JL. Supporting breastfeeding in the neonatal intensive care unit: rush mother’s milk club as a case study of evidence-based care. Pediatr Clin North Am. 2013b;60:209–26.CrossRefPubMedGoogle Scholar
  43. Meinzen-Derr J, Poindexter B, Wrage L, Morrow AL, Stoll B, Donovan EF. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J Perinatol. 2009;29:57–62.PubMedCentralCrossRefPubMedGoogle Scholar
  44. Miller EM, Aiello MO, Fujita M, Hinde K, Milligan L, Quinn EA. Field and laboratory methods in human milk research. Am J Hum Biol. 2013;25:1–11.CrossRefPubMedGoogle Scholar
  45. Miracle DJ, Meier PP, Bennett PA. Mothers’ decisions to change from formula to mothers’ milk for very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs. 2004;33:692–703.CrossRefPubMedGoogle Scholar
  46. Molinari CE, Casadio YS, Hartmann BT, et al. Proteome mapping of human skim milk proteins in term and preterm milk. J Proteome Res. 2012;11:1696–714.CrossRefPubMedGoogle Scholar
  47. Montagne P, Cuilliere ML, Mole C, Bene MC, Faure G. Immunological and nutritional composition of human milk in relation to prematurity and mother’s parity during the first 2 weeks of lactation. J Pediatr Gastroenterol Nutr. 1999;29:75–80.CrossRefPubMedGoogle Scholar
  48. Neville MC, Keller RP, Seacat J, Casey CE, Allen JC, Archer P. Studies on human lactation. I. within-feed and between-breast variation in selected components of human milk. Am J Clin Nutr. 1984;40:635–46.PubMedGoogle Scholar
  49. Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am. 2001;48:35–52.CrossRefPubMedGoogle Scholar
  50. Parker LA, Neu J, Torrazza RM, Li Y. Scientifically based strategies for enteral feeding in premature infants. Neo Reviews. 2013;14:e350.Google Scholar
  51. Patel S, Srinivasan M. Metabolic programming in the immediate postnatal life. Ann Nutr Metab. 2011;58 Suppl 2:18–28.PubMedCentralCrossRefPubMedGoogle Scholar
  52. Patel AL, Johnson TJ, Engstrom JL, Fogg LF, Jegier BJ, Bigger HR, Meier PP. Impact of early human milk on sepsis and health care costs in very low birthweight infants. J Perinatol. 2013;33:514–9.PubMedCentralCrossRefPubMedGoogle Scholar
  53. Patel AL, Bigger HR, Chen Y, Engstrom JL, Dabrowski AE, Meier PP. Human milk: impact on growth versus chronic lung disease in very low birthweight infants. 2014. (PAS Abstract).Google Scholar
  54. Penn AH. Digested formula but not digested fresh human milk causes death of intestinal cells in vitro: implications for necrotizing enterocolitis. Pediatr Res. 2012;72:560–7.PubMedCentralCrossRefPubMedGoogle Scholar
  55. Rautava S, Lu L, Nanthakumar NN, Dubert-Ferrandon A, Walker WA. TGF-beta2 induces maturation of immature human intestinal epithelial cells and inhibits inflammatory cytokine responses induced via the NF-kappaB pathway. J Pediatr Gastroenterol Nutr. 2012;54:630–8.PubMedCentralCrossRefPubMedGoogle Scholar
  56. Rodriguez NA, Meier PP, Groer MW, Zeller JM. Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives. J Perinatol. 2009;29:1–7.PubMedCentralCrossRefPubMedGoogle Scholar
  57. Rossman B, Engstrom JL, Meier PP, Vonderheid SC, Norr KF, Hill PD. “They’ve walked in my shoes”: mothers of very low birth weight infants and their experiences with breastfeeding peer counselors in the neonatal intensive care unit. J Hum Lact. 2011;27:14–24.CrossRefPubMedGoogle Scholar
  58. Rossman B, Engstrom JL, Meier PP. Healthcare providers’ perceptions of breastfeeding peer counselors in the neonatal intensive care unit. Res Nurs Health. 2012;35:460–74.PubMedCentralCrossRefPubMedGoogle Scholar
  59. Rossman B, Kratovil AL, Greene MM, Engstrom JL, Meier PP. “I have faith in my milk”: the meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit. J Hum Lact. 2013;29:359–65.CrossRefPubMedGoogle Scholar
  60. Rozé JC, Darmaun D, Boquien CY, Flamant C, Picaud JC, Savagner C, Claris O, Lapillonne A, Mitanchez D, Branger B, Simeoni U, Kaminski M, Ancel PY. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open. 2012;5;2(2):e000834.Google Scholar
  61. Sangild PT. Gut responses to enteral nutrition in preterm infants and animals. Exp Biol Med. 2006;231:1695–711.Google Scholar
  62. Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics. 1999;103:1150–7.CrossRefPubMedGoogle Scholar
  63. Schanler RJ, Lau C, Hurst NM, Smith EOB. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics. 2005;116:400–6.CrossRefPubMedGoogle Scholar
  64. Schultz C, Temming P, Bucsky P, Gopel W, Strunk T, Hartel C. Immature anti-inflammatory response in neonates. Clin Exp Immunol. 2004;135:130–6.PubMedCentralCrossRefPubMedGoogle Scholar
  65. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics. 2006;117:e67–75.CrossRefPubMedGoogle Scholar
  66. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O’Shea TM. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007;27:428–33.CrossRefPubMedGoogle Scholar
  67. Sisk PM, Lovelady CA, Gruber KJ, Dillard RG, O’Shea TM. Human milk consumption and full enteral feeding among infants who weigh >/= 1250 grams. Pediatrics. 2008;121:e1528–33.CrossRefPubMedGoogle Scholar
  68. Stellwagen LM, Vaucher YE, Chan CS, Montminy TD, Kim JH. Pooling expressed breastmilk to provide a consistent feeding composition for premature infants. Breastfeed Med. 2013;8:205–9.CrossRefPubMedGoogle Scholar
  69. Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156:562–7.e1.CrossRefPubMedGoogle Scholar
  70. Taylor SN, Basile LA, Ebeling M, Wagner CL. Intestinal permeability in preterm infants by feeding type: Mother’s milk versus formula. Breastfeed Med. 2009;4:11–5.PubMedCentralCrossRefPubMedGoogle Scholar
  71. Tudehope DI. Human milk and the nutritional needs of preterm infants. J Pediatr. 2013;162(3 Suppl):S17–25.CrossRefPubMedGoogle Scholar
  72. Tudehope D, Fewtrell M, Kashyap S, Udaeta E. Nutritional needs of the micropreterm infant. J Pediatr. 2013;162(3 Suppl):S72–80.CrossRefPubMedGoogle Scholar
  73. Underwood MA. Human milk for the premature infant. Pediatr Clin North Am. 2013;60:189–207.PubMedCentralCrossRefPubMedGoogle Scholar
  74. Vohr BR, Poindexter BB, Dusick AM, et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006;118:e115–23.CrossRefPubMedGoogle Scholar
  75. Vohr BR, Poindexter BB, Dusick AM, et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007;120:e953–9.CrossRefPubMedGoogle Scholar
  76. Wagner CL, Taylor SN, Johnson D. Host factors in amniotic fluid and breast milk that contribute to gut maturation. Clin Rev Allergy Immunol. 2008;34:191–204.CrossRefPubMedGoogle Scholar
  77. Walker A. Breast milk as the gold standard for protective nutrients. J Pediatr. 2010;156:S3–7.CrossRefPubMedGoogle Scholar
  78. Wells JM, Rossi O, Meijerink M, van Baarlen P. Epithelial crosstalk at the microbiota-mucosal interface. Proc Natl Acad Sci U S A. 2011;108 Suppl 1:4607–14.PubMedCentralCrossRefPubMedGoogle Scholar
  79. Yu LC, Wang JT, Wei SC, Ni YH. Host-microbial interactions and regulation of intestinal epithelial barrier function: from physiology to pathology. World J Gastrointest Pathophysiol. 2012;3:27–43.PubMedCentralCrossRefPubMedGoogle Scholar
  80. Ziegler EE. Meeting the nutritional needs of the low-birth-weight infant. Ann Nutr Metab. 2011;58 Suppl 1:8–18.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Paula P. Meier
    • 1
    • 2
  • Aloka L. Patel
    • 1
  • Harold R. Bigger
    • 1
  • Yimin Chen
    • 3
  • Tricia J. Johnson
    • 4
  • Beverly Rossman
    • 2
  • Janet L. Engstrom
    • 2
  1. 1.Department of Pediatrics, Section of NeonatologyRush University Medical CenterChicagoUSA
  2. 2.Department of Women, Children and Family NursingRush University Medical CenterChicagoUSA
  3. 3.Department of Clinical NutritionRush University Medical CenterChicagoUSA
  4. 4.Department of Health Systems ManagementRush University Medical CenterChicagoUSA

Personalised recommendations