Exclusive human milk diet for preterm neonates

Czech version

Authors: J. Dušek ^1,2; J. Dušková ^3,4; L. Nedvědová ¹
Authors‘ workplace: Neonatologické oddělení Nemocnice České Budějovice, a. s. ¹; Zdravotně sociální fakulta Jihočeské univerzity v Českých Budějovicích ²; Anesteziologické resuscitační oddělení Nemocnice České Budějovice, a. s. ³; University Hospital of Umeå, Sweden ⁴
Published in: Čes-slov Neonat 2025; 31 (2): 79-84.
Category: Original Paper

Overview

Introduction: Nutrition of preterm infants (< 28 weeks of gestation) is crucial for their postnatal growth, immune protection, and neurological development. While breast milk is the optimal source of nutrition, it often fails to meet the recommended daily intake of protein and energy without fortification. Bovine milk-based fortifiers (BMBF) are commonly used but may increase osmolality and reduce feeding tolerance. An alternative strategy is the exclusive human diet [1], consisting solely of human milk and human milk-derived fortifiers (HMF).

Objective: This review aims to compare the efficacy of EHD versus BMBF in relation to morbidity, mortality, growth parameters, and neurodevelopmental outcomes in preterm infants. Special attention is given to an ongoing study in České Budějovice evaluating the use of HMF derived from the mother’s own milk.

Methods: A literature review was conducted using Web of Science, PubMed, and Scopus. Included studies evaluated the incidence of necrotizing enterocolitis [2], bronchopulmonary dysplasia (BPD), late-onset sepsis (LOS), intraventricular hemorrhage/periventricular leukomalacia (IVH/PVL), as well as growth and neurodevelopmental outcomes. Economic aspects of nutritional strategies were also considered.

Results: The analysis revealed that EHD is safe and, in some studies, associated with reduced rates of NEC, IVH, and mortality. EHD also shortened the duration of parenteral nutrition and hospitalization, resulting in significant cost savings. Its neuroprotective effects are likely mediated by bioactive components such as growth factors (TGF-β, EGF) and microRNAs. While some cohorts showed slightly poorer anthropometric outcomes, these may reflect suboptimal personalization of fortification. Local production of HMF from mothers’ own milk is an emerging approach with promising clinical potential.

Conclusion: The exclusive human diet represents a promising and physiologically appropriate nutritional strategy for high-risk preterm infants. It is associated with potential reductions in morbidity and mortality, improved neurodevelopment, and economic benefits. Broader implementation will depend on improved access to HMF, individualized nutritional planning, and further targeted research.

Keywords:

Retinopathy – bronchopulmonary dysplasia – necrotizing enterocolitis – exclusive human diet – human milk fortification – late-onset neonatal infection – cost-effectiveness

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