Feeding premature infants poses a unique set of challenges, requiring specialized care and attention. Extremely premature infants, born before 28 weeks of gestation, often face difficulties in oral feeding due to underdeveloped sucking and swallowing reflexes. In such cases, the use of an Exclusive Human Milk Diet (EHMD) has gained prominence as a preferred method for nourishing preterm infants. However, the implementation of EHMD is not without its challenges. This blog explores the obstacles associated with EHMD and provides strategies to overcome these hurdles, ensuring optimal nutrition and development for premature infants.

Understanding EHMD

EHMD involves feeding preterm infants with a diet consisting exclusively of human milk, including human-based fortifiers and, when necessary, donor human milk. The rationale behind EHMD lies in the numerous health benefits associated with human milk, particularly for premature infants. Human milk contains essential nutrients, antibodies, and growth factors that support the development of the immature gastrointestinal and immune systems of preterm infants.

Challenges in Implementing EHMD

Limited Availability of Donor Human Milk

• One of the primary challenges in implementing EHMD is the limited availability of donor human milk. While human milk banks exist, they may not always have an adequate supply to meet the demands of all premature infants.

• Solution: To address this challenge, hospitals and healthcare facilities should establish partnerships with human milk banks, promote awareness about the importance of donating human milk, and implement policies to ensure a consistent supply.

Cost Constraints

• EHMD, particularly when fortified with human milk-based fortifiers, can be more expensive than other feeding options. This cost constraint may limit its accessibility for some neonatal intensive care units (NICUs) or families.

• Solution: Hospitals can explore cost-effective procurement options and advocate for insurance coverage to make EHMD more financially viable. Additionally, supporting research and development in this field can lead to innovations that reduce production costs.

Lack of Standardized Protocols

• The absence of standardized protocols for implementing EHMD can lead to variations in feeding practices across different healthcare institutions. This lack of consistency may impact the overall success of EHMD.
• Solution: Collaborative efforts within the healthcare community are essential to establish evidence-based guidelines and protocols for EHMD implementation. Professional organizations and healthcare providers should work together to develop standardized practices and share best practices.

Infant Tolerance and Digestive Challenges

• Premature infants may experience challenges due to their immature digestive systems. Digestive issues such as necrotizing enterocolitis (NEC) can pose a significant risk.
• Solution: Implementing a gradual introduction of EHMD, closely monitoring infant tolerance, and adjusting feeding plans based on individual needs can help address digestive challenges. Regular medical assessments and communication between healthcare providers and families are crucial in managing these issues effectively.

Educational Gaps and Training Needs

• Healthcare providers may lack adequate training and education on EHMD, leading to variations in implementation and potential gaps in understanding the importance of exclusive human milk feeding.
• Solution: Incorporating EHMD training into the curriculum for neonatal care professionals, ongoing education programs, and the development of accessible resources can bridge these educational gaps. Knowledge dissemination through conferences and workshops can further enhance awareness and understanding.

Strategies to Overcome EHMD Implementation Hurdles

•  Establishing Multidisciplinary Teams

Forming multidisciplinary teams comprising neonatologists, lactation consultants, dietitians, and nurses can ensure a comprehensive approach to EHMD implementation. Each team member brings unique expertise, contributing to the success of EHMD in NICUs.

• Continuous Monitoring and Evaluation

Implementing a robust system for monitoring and evaluating EHMD outcomes is crucial. Regular assessments of infant growth, tolerance, and overall health can help identify and address challenges promptly.

• Community Engagement and Education

Engaging with the community to raise awareness about the importance of human milk donation and EHMD can foster support. Community education programs can dispel myths and provide accurate information to families, encouraging them to participate in the donation process.

• Research and Innovation

Encouraging research in the field of neonatology and EHMD can lead to innovations that address cost constraints, improve product formulations, and enhance overall outcomes. Supporting initiatives for clinical trials and studies can contribute valuable data to guide evidence-based practices.

• Advocacy for Policy Changes

Healthcare institutions and professionals can advocate for policy changes at regional and national levels to prioritize and support EHMD implementation. This includes advocating for insurance coverage, government funding, and the inclusion of EHMD in clinical practice guidelines.

Conclusion

Feeding premature infants with EHMD is a promising approach to providing optimal nutrition and fostering healthy development. However, addressing the challenges associated with its implementation requires a concerted effort from healthcare professionals, institutions, and the community. By establishing standardized protocols, addressing financial constraints, promoting education, and advocating for policy changes, we can overcome these hurdles and ensure that EHMD becomes a widely accessible and successful feeding option for premature infants. The ongoing commitment to research and innovation will further enhance our understanding and implementation of EHMD, ultimately improving the outcomes for the most vulnerable members of our population.

References

1. Cristofalo EA, Schanler RJ, Blanco CL, et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr. 2013;163(6):1592-1595.e1. doi:10.1016/j.jpeds.2013.07.011
2. American Academy of Pediatrics. (2021). Breastfeeding and the Use of Human Milk. [https://pediatrics.aappublications.org/content/129/3/e827]
3. National Association of Neonatal Nurses. (2021). Position Statement: Human Milk and Breastfeeding. [https://nann.org/docs/default-source/position-statements/humanmilkandbreastfeeding.pdf]
4. Assad M, Elliott MJ, Abraham JH, (2016). Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet. JPEN Journal of Parenteral and Enteral Nutrition, 40(6), 656-663. [DOI: 10.1177/0148607115592288]
5. Centers for Disease Control and Prevention. (2021). Breastfeeding Data and Statistics. [https://www.cdc.gov/breastfeeding/data/index.htm]
6. Meier P, Patel AL, Wright K, Engstrom JL. Management of breastfeeding during and after the maternity hospitalization for late preterm infants. Clin Perinatol. 2013;40(4):689-705. doi:10.1016/j.clp.2013.07.014