In‐hospital Growth of Very Low Birth Weight Preterm Infants

Abstract

Objective: Amidst a high prevalence of prematurity, limited research on the growth of very low birth weight (VLBW) preterm infants and the availability of a reformulated fortifier c(RF), the study aimed to compare in-hospital growth of such infants receiving exclusively human milk fortified with either of 2 different formulations in a tertiary South African hospital. Methods: In a prospective comparative effectiveness design, intakes and growth of VLBW infants on the Original Fortifier (OF; 2016–2017) were compared with those receiving RF (2017–2018). Daily intake was calculated using published composition of preterm and mature milk with fortifier (OF: 0.2 g protein, 3.5kcal/g powder; RF: 0.4 g protein, 4.4 kcal/g powder). Change in z scores from start to end of fortification for weight (WFAZ), length (LFAZ), and head circumference (HCFAZ) for age was the primary outcome. Additionally, weight gain velocity (g · kg−1 · day−1) and gain in length and head circumference (HC) (cm/week) were calculated. Results: Fifty-eight infants (52% girls; gestational age: 30 ± 2 weeks; birth weight: 1215 ± 187 g) received OF for 16 days and 59 infants (56% girls; gestational age: 29 ± 2 weeks; birth weight 1202 ± 167 g) received RF for 15 days. Protein intake of RF (3.7 ± 0.4 g · kg−1 · day−1) was significantly higher (P < 0.001) than of OF (3.4 ± 0.2 g · kg−1 · day−1). Protein-to-energy ratio of RF (2.6 ± 0.2 g/100 kcal) was significantly higher (P < 0.001) than of OF (2.3 ± 0.1 g/100 kcal). In both groups, WFAZ and LFAZ decreased; HCFAZ improved slightly. No significant differences (P > 0.05) were noted between the 2 groups for change in z scores, weight gain velocity, length or HC gain. Conclusions: Despite a modest increase in protein intake and protein-to-energy ratio, the growth of VLBW infants on RF was not better than on OF during their hospital stay.

High protein content in breast milk from South African mothers of preterm infants

“…In this exploratory study, the nutritional content of milk from South African mothers with preterm babies and living in a resource‐constrained setting differs from published data. As part of a larger study 19 on growth in preterm infants receiving fortified human milk based on the values recommended by Cormack et al 18 this sub‐study investigated the clinical implications for the care of preterm infants in LMIC when using high income country nutrient values for human milk.…”

“…A single‐centre observational study nested in a larger investigation, namely ‘Growth of preterm infants receiving fortified human milk’, 19 was designed, following the STROBE guidelines 20 . The setting reflects real‐life practices at the study hospital where lodging facilities and rooming‐in for mothers are limited.…”

“…The aim of our study was to explore the macronutrient (primarily protein) and energy content of transition and mature human milk from mothers who gave birth to preterm infants, that is, less than 37 weeks completed gestation, with a birth weight of 1800 g or less in a tertiary academic hospital serving a resource‐limited community in Gauteng, South Africa and to compare it to published data. As part of a larger study 19 on growth in preterm infants receiving fortified human milk based on the values recommended by Cormack et al 18 this sub‐study investigated the clinical implications for the care of preterm infants in LMIC when using high income country nutrient values for human milk.…”

What are the effects of individualized diet fortification for growth and development in infants born preterm receiving human milk? A Cochrane Review summary with commentary

“…[2][3][4][5] Therefore, nutrient fortification of human milk might be useful in infants born preterm, especially those born with a very low birthweight with comorbidities. 6 Currently, there are three main strategies: standard, adjustable, and targeted fortification. 1,7 However, growth failure is still common in neonatal intensive care units.…”

“…However, the content of human milk does not alone meet all the nutritional requirements for growing infants born preterm due to different reasons such as feed intolerance or respiratory distress 2–5 . Therefore, nutrient fortification of human milk might be useful in infants born preterm, especially those born with a very low birthweight with comorbidities 6 . Currently, there are three main strategies: standard, adjustable, and targeted fortification 1,7 .…”