Concentrated Preterm Formula as a Liquid Human Milk Fortifier at Initiation Stage in Extremely Low Birth Weight Preterm Infants: Short Term and 2-year Follow-up Outcomes

Abstract

Human milk (HM) must be accurately fortified for extremely low birth weight (ELBW) preterm infants with human milk fortifiers (HMFs). Powdered HMF has some limitations in terms of sterilization and accuracy. A concentrated preterm formula (CPF) may serve as a safe liquid HMF to facilitate growth. Hence, we launched a quality improvement project for fortification accuracy of minute volume HM. A CPF, Similac Special Care 30 (SSC30), was newly introduced as an HMF when daily feeding reached 100 cm3/kg. CPF + HM (1:2 volume ratio), CPF + HM (1:1 volume ratio), and powdered HMF + HM (1 packet in 25 cm3) represented three fortification stages. Fortification shifted to powdered HMF while tolerable feeding reached 25 cm3/meal. The outcome was compared before (Period-I, January 2015 to June 2016, n = 37) and after the new implement (Period-II, July 2016 to December 2017, n = 36). Compared with the Period-I group, the Period-II group had significantly higher daily enteral milk intake in the first 4 weeks of life, and higher percentages of fortification in the HM-fed infants in the first 8 weeks after birth. The Period-II group also significantly increased in body weight growth in terms of z-score at term equivalent age (p = 0.04) and had better language and motor performance at 24 months old (p = 0.048 and p = 0.032, respectively). Using the liquid CPF as a strategical alternative fortification of HM might be beneficial for extremely preterm infants in terms of growth as well as neurodevelopment.

Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015

“…Enteral feeding started with the trophic mother’s own breast milk or human donor milk; this was maintained for 3 to 5 days and increased to 10–20 mL/kg/d if infants were able to tolerate it. Fortification began when the daily enteral feeding was providing more than 100 mL/kg/d [ 26 ].…”

Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome

“…Data on respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) [21], retinopathy of prematurity (ROP), postnatal steroids therapy, chronic lung disease (CLD) [22], periventricular leukomalacia (PVL), duration of invasive ventilation, and postnatal steroid therapy for CLD, respiratory support status, PNA and postmenstrual age (PMA) were obtained at discharge [18,23].…”

Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant

“…Except for being small for his gestational age, he had no other complicated maternal history. Soon after birth, he received nasal noninvasive respiratory support, amnio-acid infusion (3 g/kg/day), and trophic feeding (10 mL/kg/day) with breast milk as dictated by the protocol in [ 21 ]. His vital signs (heart rate at 167 beats per minute, blood pressure at 43/25 mmHg, and respiratory rate at 31 per minute) soon after birth were stable.…”

“…After surgery, only parenteral nutrition (110–120 kcal/kg/day with amino acids at 3.5 g/kg/day and lipids at 3 g/kg/day) was administered per our reported protocol [ 21 ]. After the tarry stool problem was resolved, the infant was extubated on the 16th DOL.…”