Optimizing the Use of Human Milk Cream Supplement in Very Preterm Infants: Growth and Cost Outcomes

Background An exclusive human milk–based diet has been shown to decrease necrotizing enterocolitis and improve outcomes for infants ≤1250 g birth weight. Studies have shown that infants who received an exclusive human milk diet with a donor‐human milk–derived cream supplement (cream) had improved weight and length velocity when the cream was added to mother's own milk or donor‐human milk when energy was <20 kcal/oz using a human milk analyzer. Our objective was to compare growth and cost outcomes of infants ≤1250 g birth weight fed with an exclusive human milk diet, with and without human milk cream, without the use of a human milk analyzer. Methods Two cohorts of human milk–fed premature infants were compared from birth to 34 weeks postmenstrual age. Group 1 (2010–2011) received a donor‐human milk fortifier, whereas Group 2 (2015–2016) received donor‐human milk fortifier plus the commercial cream supplement, if weight gain was <15 g/kg/d. Results There was no difference in growth between the 2 groups for weight ( P = 0.32) or head circumference ( P = 0.90). Length velocity was greater for Group 1 ( P = 0.03). The mean dose of donor‐human milk fortifier was lower in Group 2 ( P < 0.001). Group 2 saved an average of $2318 per patient on the cost of human milk products ( P < 0.01). Conclusions Infants receiving a human milk diet with cream supplementation for growth faltering achieve appropriate growth in a cost‐effective feeding strategy.