Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

Abstract

BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500-1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median ± IQR range for gestational age (27.6 ± 3.4 vs 27.0 ± 2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9 ± 2.6 vs 13.3 ± 2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification.

Is preterm donor milk better than preterm formula for very-low-birth-weight infants?

“…Another solution, according to the recommendations of the American Academy of Pediatrics and the Chinese Academy of Pediatrics, is the reasonable fortification of milk to meet the protein and mineral needs of VLBW infants. Early fortification appears to positively affect growth in the absence of any adverse effects, as intensive breastfeeding and PF-fed preterm infants have similar growth rates during hospitalization and can reach normal in utero fetal growth rates ( 11 , 12 ). Additionally, further research should be conducted on processing DM through methods such as ultra-pasteurization or non-thermal methods, as this could further reduce the loss of fat and nutrients ( 13 ).…”

The Impact of Homogenization on Donor Human Milk and Human Milk–Based Fortifiers and Implications for Preterm Infant Health

“…Even so, there is currently no clinical evidence demonstrating that this translates into improved or more appropriate growth outcomes in premature infants. In contrast, HM-based nutritional products produced from nonhomogenized HM have been shown in clinical studies to result in adequate growth without long-term insulin resistance and excess adiposity in infants born weighing ≤1250 g ( 11 , 21–24 ).…”

“…The benefits derived from an EHMD diet are 2-fold: delivering the nutrition required to offset missed nutrient accretion that occurs during the third trimester and reducing the complications associated with enteral feeding ( 2 , 10 , 11 ). Before the advent of HM-based fortifiers, MOM or DHM was fortified with cow milk–based fortifiers.…”

“…Currently available products include DHM, HM-based multinutrient fortifiers, and HM-based caloric fortifiers. These products are used in combination with MOM and/or DHM under the direction of health care professionals to meet the individual nutritional needs of the most medically fragile infants ( 2–8 , 11 , 12 ). Importantly, however, not all HM-based nutritional products are created equally.…”

Supplementation of Mother’s Own Milk with Preterm Donor Human Milk: Impact on Protein Intake and Growth in Very Low Birth Weight Infants—A Randomized Controlled Study

“…After this short period, preterm MOM needs fortification in order to meet the nutrient requirements of VLBW infants whose needs are dynamic and related to postnatal age, severity of illness, and need for catch-up growth [ 20 , 21 , 22 ]. In most neonatal intensive care units (NICUs), fortification is initiated when the fed milk volume reaches 50–100 mL/kg/day [ 23 , 24 ]. However, for VLBW infants, this delay may result in significant protein deficit during the first weeks of life.…”