Implementing EHMD: Best Practices and Protocols

Implementing EHMD: Best Practices and Protocols

Welcoming a preterm infant into the world marks the beginning of an intricate and delicate journey, where every ounce of care contributes significantly to their growth and development. In recent years, the implementation of Exclusive Human Milk Diet (EHMD) has emerged as a cornerstone in neonatal care, offering a tailored approach to meet the unique nutritional needs of preterm infants. In this blog post, we will explore the best practices, protocols, and procedures for successfully implementing EHMD in neonatal care units and hospitals, ensuring that each tiny patient receives the optimal start to life.

Understanding the Significance of EHMD

EHMD involves providing preterm infants with a diet exclusively composed of human milk, whether from the mother or a carefully screened donor. This approach intentionally excludes other sources of nutrition, such as cow’s milk-based fortifiers, recognizing the unparalleled nutritional richness of human milk for the optimal development of preterm infants.

Protocols and Procedures for EHMD Implementation

  1. Early Initiation and Monitoring
  • Best Practice: Initiate EHMD as early as possible, ideally within the first 24 to 48 hours of life.
  • Protocol:  Implement a systematic approach for early initiation, ensuring that infants receive the benefits of human milk from the outset. Monitor the initiation process closely, assessing the infant’s tolerance and adjusting the feeding plan accordingly.
  1. Lactation Support and Education
  • Best Practice: Provide robust lactation support to mothers, emphasizing the importance of breastfeeding and pumping.
  • Protocol: Establish lactation support programs within the neonatal care unit. Offer education sessions to mothers on the benefits of EHMD, proper breastfeeding techniques, and effective breast pumping to maintain milk supply.
  1. Donor Milk Screening and Processing
  • Best Practice: Utilize donor human milk when mother’s milk is unavailable, ensuring stringent screening and processing protocols.
  • Protocol: Collaborate with certified milk banks and adhere to strict screening procedures for donor human milk. Implement pasteurization processes to maintain safety standards while preserving the nutritional integrity of the milk.
  1. Multidisciplinary Collaboration
  • Best Practice: Foster interdisciplinary collaboration between neonatologists, nurses, lactation consultants, and dietitians.
  • Protocol: Conduct regular interdisciplinary team meetings to discuss individual cases, assess growth and nutritional needs, and make collaborative decisions regarding EHMD implementation. This ensures a holistic and integrated approach to neonatal care.
  1. Monitoring Growth and Adjusting Feeding Plans
  • Best Practice: Regularly monitor the growth and nutritional status of infants on EHMD.
  • Protocol: Implement a structured system for growth monitoring, incorporating regular assessments by healthcare providers. Adjust feeding plans based on individualized needs, ensuring that each infant receives the optimal amount of nutrients for their developmental stage.
  1. Parental Involvement and Education
  • Best Practice: Involve parents in the EHMD process, providing education and support.
  • Protocol: Develop educational materials and workshops for parents, explaining the benefits of EHMD and guiding them in the care and feeding of their preterm infants. Encourage parental participation in the caregiving process, fostering a sense of empowerment and involvement.
  1. Transitioning to Breastfeeding
  • Best Practice: Facilitate the transition from tube feeding to breastfeeding when the infant is developmentally ready.
  • Protocol: Develop standardized protocols for assessing developmental readiness for breastfeeding. Implement gradual transitions under the guidance of lactation consultants, ensuring a smooth progression from tube feeding to breastfeeding.

Benefits of EHMD Implementation

  • Reduced Risks of Necrotizing Enterocolitis (NEC):

Studies, including those by Lucas et al., consistently demonstrate a lower incidence of NEC in preterm infants fed an EHMD, highlighting the protective effects of human milk against this severe condition.

  • Enhanced Neurodevelopmental Outcomes:

Research, such as the work of Cunningham et al., associates EHMD with improved cognitive and motor skills in the long term, emphasizing the positive impact on neurodevelopmental outcomes.

  • Lower Rates of Sepsis and Infections:

A systematic review and meta-analysis by Patel et al. demonstrate the immune-boosting properties of human milk, resulting in lower rates of sepsis and infections in preterm infants fed an EHMD.


Implementing Exclusive Human Milk Diet in neonatal care units and hospitals requires a thoughtful combination of best practices and well-defined protocols. By prioritizing early initiation, providing robust lactation support, screening and processing donor milk meticulously, fostering multidisciplinary collaboration, and monitoring growth with regular adjustments, healthcare providers can ensure that preterm infants receive the optimal care they need for a healthy start in life. Through these practices, neonatal care units can become nurturing environments where each tiny patient thrives on the tailored benefits of EHMD, setting the stage for a brighter and healthier future.


  1. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet. 1990;336(8730):1519-1523. doi:10.1016/0140-6736(90)93304-8
  2. Ejlerskov KT, Christensen LB, Ritz C, Jensen SM, Mølgaard C, Michaelsen KF. The impact of early growth patterns and infant feeding on body composition at 3 years of age. Br J Nutr. 2015;114(2):316-327. doi:10.1017/S0007114515001427
  3. Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2019;7(7):CD002971. Published 2019 Jul 19. doi:10.1002/14651858.CD002971.pub5
  4. Patel AL, Kim JH. Human milk and necrotizing enterocolitis. Semin Pediatr Surg. 2018;27(1):34-38. doi:10.1053/j.sempedsurg.2017.11.007
  5. Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet. 1992;339(8788):261-264. doi:10.1016/0140-6736(92)91329-7
  6. Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014;14:216. Published 2014 Aug 30. doi:10.1186/1471-2431-14-216

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