Human milk feedings in the neonatal intensive care unit

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, antioxidant, 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.