Benefits of an Exclusive Human Milk Diet in a Very Preterm Infant With an Ileostomy: A Case Report

Mother's milk (MOM) provides numerous benefits for very preterm infants; however, it requires fortification to achieve appropriate nutrition intake. Although cow milk-based human milk fortifier (CMHMF) is widely used in Japan, it poses a risk of fatty acid calcium formation in infants with ileostomy. An exclusive human milk diet (EHMD) uses only human milk products to fortify MOM or donor human milk using a human milk-based human milk fortifier. Compared to CMHMF, EHMD reduces feeding intolerance and necrotizing enterocolitis in premature infants and may be safely used in infants with an ileostomy. However, specific studies addressing the nutritional effects of EHMD in these patients are lacking. This case report discusses the potential benefits of an EHMD in an infant undergoing ileostomy. The male infant, weighing 742 g, was delivered by emergency cesarean section at the postmenstrual age of 26 weeks and three days. On day eight of life, the patient underwent intestinal resection and anastomosis for a localized intestinal perforation. CMHMF could not be used because of the risk of fatty acid calcium stone formation. Given concerns regarding malnutrition, the case was administered an EHMD. Following the introduction of EHMD, his weight gain improved from 5 g/day to 17 g/day, and his z-score improved from -0.8 standard deviation (SD) to +0.3 SD. No adverse events were observed. It is suspected that the improvement in the anthropometric data was attributable to the establishment and maintenance of full feeding volumes alongside the EHMD, which ensured adequate nutrition and increased nutritional intake. This case suggests that EHMD may be a safe and effective nutritional strategy to promote optimal growth and development in infants undergoing abdominal surgery.