Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring?

Objective:the objective of this study was to compare the currently used human milk (hm) quality indicators that measure whether very low-birthweight (vlbw; <1500 g birthweight) infants ‘ever’ received hm and whether they were still receiving hm at discharge from the neonatal intensive care unit (nicu) to the actual amount and timing of hm received.study design:this study used data from a large nih-funded cohort study and calculated whether vlbw infants ever received hm (hm-ever) and of these infants, the percentage who were still receiving hm at nicu discharge (hm-dc). then, the hm-dc indicator (exclusive, partial and none) was compared with the amount and timing of hm feedings received by these same infants.result:of the 291 vlbw infants who met inclusion criteria, 285 received some hm (hm-ever=98%). at nicu discharge (hm-dc), 24.2, 15.1 and 60.7% were receiving exclusive, partial and no hm, respectively. of the 60.7% infants with no hm-dc, some had received higher amounts of hm during the nicu hospitalization than infants categorized as exclusive and partial for hm-dc. of the infants with no hm-dc, 76.8 and 59.7% had received exclusive hm during the days 1–14 and days 1–28 exposure periods, respectively.conclusion:the average daily dose (hm-dd; in ml kg−1 d−1) and cumulative percentage (hm-pct; as % of cumulative enteral intake) of hm feedings were sufficient to significantly reduce the risk of multiple morbidities, including late-onset sepsis, necrotizing enterocolitis, neurocognitive delay and rehospitalization, in the majority of the vlbw infants who were discharged with no hm-dc. quality indicators that focus on the amount and timing of hm feedings in the nicu should be added to the hm-ever and hm-dc measures.