World Prematurity Day: EHMD Is More Than Nutrition, It's Medicine

Prematurity is one of the most prevalent causes of neonatal mortality throughout the world. Since these infants are born before time, premature mortality is primarily related to the immaturity of the vital organs making them prone to higher risk of infections.

According to Dr Geetika Gangwani, EHMD provides numerous benefits to preterm infants and should therefore be included in NICU protocols. Human milk- derived nutritional products, such as human milk-based fortifier, are deemed safe and well tolerated and would be helpful in implementing EHMD in NICUs. For EHMD to be ensured, the availability of pasteurized donor human milk must be facilitated by strengthening the human milk donation and awareness measures.

Research has shown that infants who are fed an exclusive human milk diet (EHMD) have fewer respiratory complications and gastrointestinal infections among other serious health problems.  

Dr Naveen Prakash Gupta, Senior Consultant Neonatalogy, Madhukar Rainbow Children’s Hospital, Delhi says, “We recommend an exclusive human milk diet for all infants, especially those born prematurely and/or weigh less than 1500 grams. EHMD has shown to minimise risks, which otherwise would be higher when bovine milk-based products are used in the baby’s diet."

100% exclusive human milk diet

An exclusive human milk diet is a combination of Mother's Milk, screened pasteurised human milk from a qualified donor and a human milk-based fortifier when required.

“EHMD can help reduce the risk of life-threatening conditions such as Sepsis and Necrotising Enterocolitis which are common for premature infants,” says Dr Naveen Prakash Gupta.

Human milk diet reduce complications for babies

Human milk has immense benefits beyond just nutrition. Immunological and anti-infective components being one of the vital parts of human milk ensures protection against many viral, bacterial, and fungal infections in new-borns. This is even more important for premature babies who have immature organ and immune systems.

EHMD provides an umbrella protection for new-born babies by providing immunoglobulins which help in reducing the risk of infections and sepsis (one of the most common complications seen in premature infants) by nearly 11 per cent.

Immunoglobulins like secretory immunoglobulin A (sIgA) and IgA gets adhered to the mucosal membrane of throat, upper respiratory system and gut and ensures local protection against infections, which also help in reducing the risk of gut-related infections and diarrhoea.

Necrotising enterocolitis (NEC) occurs most often in premature or sick babies and is often life-threatening. Treatment may require invasive surgeries and can have lifelong consequences. Evidence shows incidence of NEC requiring surgery is reduced by 97 per cent by fortifying mothers' milk with a human milk-based fortifier.

Overall, there is a direct correlation between an exclusive human milk diet and lower mortality and morbidity as compared to a bovine milk-based diet. In essence, human milk has evolved over millions of years to be the optimal choice of superfood for infants. Human milk isn’t just nutrition - it’s medicine.

Tangible economic benefits

EHMD provides cost-effective benefits by reducing both direct and indirect healthcare costs,

Evidence also supports that an exclusive human milk diet has additional benefits beyond the reduction in NEC/Sepsis including reduction of IV nutrition and overall hospital stay. When compared with babies fed an exclusive human milk diet, the number of incremental days in the hospital is 22 days for babies given mixed feeds and 7 days for infants fed with formula feeds.

Importance of fortification 

●  Fortification is a process of strengthening the nutritional quality of human milk to meet the requirements of preterm infants. Since these infants are born before time, their need additional care and nutrition to catch up on the growth rates, which they would have ideally had in the mother’s womb.

●  It is done by adding the fortifier sachet containing nutrients like proteins, carbohydrates, fats, minerals and vitamins into human milk and fed to preterm infants.

●  Two types are available: bovine milk-based and human milk-based

●  Till recently only bovine milk-based fortifiers were available but, now human milk-based fortifiers are available in India as well. These human milk-based fortifiers ensure babies are not exposed to bovine milk protein thereby adhering to an Exclusive Human milk diet.

Human milk-based fortifiers are better than bovine milk-based ones

Human milk-based fortifiers or mother’s milk fortifiers are made from 100 per cent human milk without any synthetic additives or preservatives or emulsifiers. Moreover, they retain critical components of human milk such as Oligosaccharides and Immunoglobulins which are absent is any other bovine milk-based products.

We encourage parents to make an informed choice and work with their healthcare team on this vital aspect of infant feeding. Moreover, an exclusive human milk diet does not necessarily stop with hospital discharge. It can be and ideally should be continued as long as possible, even at home to ensure a stronger and healthier next generation of Indians.

Lack of awareness about milk donation preventing mothers from donating their excess milk

Despite a slow and steady increase in the number of mothers donating human milk, there is still not enough awareness amongst the general public.

Dr Naveen Prakash Gupta, Senior Consultant Neonatalogy, Madhukar Rainbow Children’s Hospital stated, "The major challenge is the lack of awareness about human milk donation. It is not difficult to donate, but due to lack of knowledge and education, many mothers don't know how and where to donate. It is important for pregnant and new mothers to be informed of the benefits of donating human milk. Because optimal nutrition for infants not only saves lives and improves the quality of life but also benefits the entire healthcare system and reduces costs over the long term."