University of Maryland Leads in Supplementing with Donor Human Milk to Promote Gut Health in Preterm Population

A study finds early cumulative human milk intake exceeding 150 ml/kg within the first 7–10 days of life, whether as mother's own milk (MOM) or supplemented with donor human milk (DHM), promotes intestinal barrier maturation and reduces intestinal permeability. 

"DHM is a very effective nutritive supplement to MOM, and a feasible dietary intervention that saves lives through promotion of intestinal barrier function within the first 7-10 days post-natal age," says Sripriya Sundararajan, MD, medical director of University of Maryland Medical Center Neonatal Intensive Care Unit (NICU). "It has proven beneficial, especially for the preterm population.”

The Level IV Drs. Rouben and Violet Jiji Neonatal Intensive Care Unit incorporates evidence-based interventions to improve neonatal outcomes by making early human milk feeding a cornerstone strategy.

Investigating Early Human Milk Feeding

Preterm infants face unique challenges due to the immaturity of their gastrointestinal systems. A hyperpermeable intestinal epithelium increases the risk of bacterial translocation, contributing to mucosal inflammation, sepsis, and necrotizing enterocolitis (NEC). Human milk, particularly when introduced early and in sufficient volumes, plays a pivotal role in mitigating these risks by promoting intestinal barrier maturation.

Dr. Sundararajan and her colleagues conducted a prospective study, published in Pediatric Research, to assess the impact of early human milk feeding on intestinal permeability in preterm infants. The study revealed that a cumulative intake of more than 150 ml/kg of MOM or MOM supplemented with DHM significantly reduces intestinal permeability, as measured by a sugar absorption test. This reduction in permeability supports the maturation of the intestinal barrier within the first week of life—a critical window for preterm infants.

"While the clinical benefits of DHM in reducing the incidence of NEC and improving long-term outcomes have been described, our study is the first to report the impact of MOM supplemented with DHM on postnatal intestinal barrier maturation and risk for post-natal growth failure (PNGF)," says Dr. Sundararajan.

Researchers noted no association between intestinal permeability and a lower risk of PNGF at discharge. Future research should analyze the impact of early intestinal barrier maturation and later growth and development.

Read the full study

Implementing Evidence-Based Guidelines

At UMMC, the NICU team advocates for early initiation of human milk feeds in the preterm population. This policy is part of a comprehensive strategy that includes encouraging MOM production, securing high-quality DHM, and using fortified feeds when necessary. These efforts align with recommendations from the American Academy of Pediatrics, which supports the use of exclusive human milk, fortified as needed, for very low birthweight infants.