Clinician enteral feeding preferences for very preterm babies in the UK

Mills, Luke; Modi, Neena

doi:10.1136/archdischild-2014-308110

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…Although rapidly increasing (8,9) , use of HDM remains highly variable (10,11) . Surveys of clinician practice suggest reduction of necrotising enterocolitis as the most important reason for feeding preterm babies HDM (10) with initiation of HDM preferred over preterm formula to supplement MOM for those at high risk, such as growth restricted or extremely preterm babies (12) . The optimal growth of preterm babies, especially for those born small for gestational age (SGA), remains to be fully described: observational, but limited interventional study data associate rapid or excessive postnatal catch up growth with long-term metabolic consequences, while postnatal growth restriction predicts adverse neurodevelopment (13) .…”

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confidence: 99%

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Mills

Coulter²,

Savage³

et al. 2019

Br J Nutr

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Better understanding of the variation in macronutrient content of human donor milk (HDM) potentiates targeted nutrition for preterm babies. The present study describes the relationship of maternal age, parity, monthly lactation stage estimate (LSEm), daily volume of milk expressed (Vd), sex, gestation and birth weight z scores with macronutrient content of HDM. Multilevel mother–infant pair ID random intercept models were performed using the predictor variables above on the outcome HDM macronutrient content determined using mid-IR spectroscopy. Mean macronutrient content was also compared by gestational age and small for gestational age (SGA) (z score < –1·28) or appropriate for gestational age (AGA) (z score ≥ –1·28) categories. A total of 2966 samples of donations from 1175 mother–infant pairs to the UK Northwest Human Milk Bank between 2011 and 2017 were analysed. Mean protein, fat, carbohydrate and calculated energy were 0·89 (SD 0·24) g/dl, 2·99 (SD 0·96) g/dl, 7·09 (SD 0·44) g/dl, and 60·37 (SD 8·41) kcal/dl (252·59 (SD 35·19) kJ/dl), respectively. Preterm SGA HDM was significantly higher in protein, fat and energy content than term AGA HDM and significantly lower in carbohydrate content than term AGA HDM after controlling for LSEm, Vd and between-subject effects. Degree of prematurity did not influence macronutrient content. Between-subject effects accounted for more of the variance in macronutrient content than the fixed effects in the model. Despite this, SGA status, as well as prematurity, may be an important determinant of macronutrient content in human milk. As bioavailability of macronutrients from HDM is uncertain, studies evaluating growth and body composition in preterm and SGA babies fed HDM are warranted.

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confidence: 99%

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Mills

Coulter²,

Savage³

et al. 2019

Br J Nutr

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“…We commenced fortification at 100mls/kg/d, which is routine practice in some countries. However, in the UK, if used, fortification is typically started at a volume of 150ml/kg/d [22]. Early use of fortifier may have introduced bias possibly influencing parent perspectives.…”

Section: Discussionmentioning

confidence: 99%

Preterm formula, fortified or unfortified human milk for very preterm infants, the PREMFOOD study, a parallel randomised feasibility trial

Mills,

Chappell,

Emsley

et al. 2023

Preprint

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ObjectiveUncertainty exists regarding optimal supplemental diet for very preterm infants if mother’s own milk (MM) is insufficient. We evaluated feasibility for a randomised controlled trial (RCT) powered to detect important differences in health outcomes.MethodsIn this open, parallel, feasibility trial, we randomised infants 25+0-31+6 weeks gestation by opt-out consent, to one of three diets: unfortified human milk (UHM) (unfortified MM and/or unfortified pasteurised human donor milk (DM) supplement; fortified human milk (FHM) (fortified MM and/or fortified DM supplement), and unfortified MM and/or preterm formula (PTF) supplement from birth to 35+0 weeks post menstrual age. Feasibility outcomes included opt-outs, adherence rates, and slow growth safety criteria. We also obtained anthropometry, and magnetic resonance imaging body composition data at term and term plus 6 weeks (opt-in consent).Results35 infants were randomised to UHM, 34 to FHM, and 34 to PTF groups, of which 21, 19, and 24 infants completed imaging at term. Study entry opt-out rate was only 38%, while 6% of parents subsequently withdrew from feeding intervention. Two infants met predefined slow weight gain thresholds. There were no significant between-group differences in total adipose tissue volume at term (mean (sd): UHM: 0.870L (0.35L); FHM: 0.889L (0.31L); PTF: 0.809L (0.25L), p=0.66), nor in any other body composition measure or anthropometry at either timepoint.ConclusionsRandomisation to UHM, FHM, and PTF feeding interventions by opt-out consent was acceptable to parents and clinical teams, associated with safe growth profiles and no significant differences in body composition. Our data provide justification to proceed to a larger RCT.

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“…Bovine multicomponent fortification of human milk has been proposed to cause inflammation [24], and there is a lack of scientific evidence about whether or not its routine use can impact growth and other short-and long-term outcomes [25]. Furthermore, there is uncertainty on whether pasteurized donated human milk should be preferred to preterm formula [26]. In clinical reality, most babies in participating GNN units receive a mix of human milk and formula while donor human milk availabilities are increasingly being established but still limited.…”

Section: Discussionmentioning

confidence: 99%

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

et al. 2020

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Objective: To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth. Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models. Results: 5954 (76.5%) infants received L. acidophilus/B. infantis prophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82–4.35; p < 0.001) but not in the F group (effect size B = −0.06; 95% CI: −3.05–0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59–0.79; p < 0.001). Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk.

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Clinician enteral feeding preferences for very preterm babies in the UK

Cited by 12 publications

References 3 publications

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

Preterm formula, fortified or unfortified human milk for very preterm infants, the PREMFOOD study, a parallel randomised feasibility trial

Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

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