Human Milk Fortification with Differing Amounts of Fortifier and Its Association with Growth and Metabolic Responses in Preterm Infants

Abstract

We demonstrated that blind fortification of HM, even with higher amounts than recommended by manufacturers, did not cause any measured adverse effects on the metabolic response of preterm infants. Anthropometric measurements (except head circumference) were not different between the different dosages of fortification.

Human milk fortification strategies for improved in-hospital growth of preterm infants

“…Hypercalcaemia may be a risk and testing serum calcium and serum phosphorous more regularly should be considered. 8 Kanmaz et al 20 ( Table 2) reported two levels of blind fortification (moderate and aggressive) compared to standard fortification in a group of ELBW and VLBW infants with a gestational age of about 28 weeks. Moderate and aggressive fortification led to non-significant increases in weight and length, but head circumference increased significantly.…”

“…According to a Cochrane review 20 on multicomponent fortification of human milk, it does not appear to be associated with adverse effects, even though the limited total sample size and missing data threaten the generalisability. As expected, increased enteral protein intake may increase blood urea levels and decrease blood pH levels, but the clinical significance thereof is unclear.…”

“…As expected, increased enteral protein intake may increase blood urea levels and decrease blood pH levels, but the clinical significance thereof is unclear. 20 In the studies summarised in Table 2, adverse effects of the alternative fortification strategies were mostly reported in terms of feeding intolerance and in changes in biochemical markers.…”

“…With the exception of increased serum urea levels in one study, 23 all changes in biochemical markers reported in the studies in Table 2, were not statistically significant. Kanmaz et al, 20 Biasini et al 23 and Rochow et al 25 are the only studies that reported on the incidence of metabolic acidosis, which were either not seen or did not occur more than prior to fortification.…”

“…, Arslanoglu et al 24 and Hair et al 26 specified that no NEC was reported in the intervention groups in their respective studies; however, Kanmaz et al 20 reported NEC in one patient in the moderate fortification group. With the exception of increased serum urea levels in one study, 23 all changes in biochemical markers reported in the studies in Table 2, were not statistically significant.…”