Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk

Fabrizio, Veronica; Trzaski, Jennifer; Brownell, Elizabeth A.; Esposito, Patricia; Lainwala, Shabnam; Lussier, Mary M.; Hagadorn, James I.

doi:10.1002/14651858.cd013465.pub2

Cited by 32 publications

(46 citation statements)

References 57 publications

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“…Altering fortification in response to blood urea has shown promise in improving growth,50 although there was significantly higher protein provision to the intervention group, meaning that it is difficult to know whether increased protein or personalisation per se was the important factor. A Cochrane review identified that targeted fortification improved weight, length and head growth during initial neonatal stay but that there was insufficient evidence for other outcomes 52…”

Section: Barriers To Achieving Nutritional Targetsmentioning

confidence: 99%

Optimising growth in very preterm infants: reviewing the evidence

Young

Beattie

Johnson

2022

Arch Dis Child Fetal Neonatal Ed

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Infants born before 32 weeks’ postmenstrual age are at a high risk of growth failure. International guidelines have long recommended that they match the growth of an equivalent fetus, despite the challenges posed by ex utero life and comorbidities of prematurity. Several groups have recently questioned the necessity or desirability of this target, shifting attention to aiming for growth which optimises important long-term outcomes. Specifically, recent research has identified the neurodevelopmental benefits of enhanced growth during the neonatal period, but work in term infant suggests that rapid growth may promote the metabolic syndrome in later life. In this context, defining a pattern of growth which optimises outcomes is complex, controversial and contested. Even if an optimal pattern of growth can be defined, determining the nutritional requirements to achieve such growth is not straightforward, and investigations into the nutritional needs of the very preterm infant continue. Furthermore, each infant has individual nutritional needs and may encounter a number of barriers to achieving good nutrition. This article offers a narrative review of recent evidence for the competing definitions of optimal growth in this cohort. It examines recent advances in the determination of macronutrient and micronutrient intake targets along with common barriers to achieving good nutrition and growth. Finally, key implications for clinical practice are set out and a recommendation for structured multidisciplinary management of nutrition and growth is illustrated.

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Section: Barriers To Achieving Nutritional Targetsmentioning

confidence: 99%

Optimising growth in very preterm infants: reviewing the evidence

Young

Beattie

Johnson

2022

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

show abstract

“…Individual fortification is performed by measuring the infant’s blood urea nitrogen (‘adjustable’ fortification) or the macronutrient content of breast milk using a milk analyzer (‘targeted’ fortification). In a recent review including 7 RCTs with a total of 521 participants, increased growth rates for weight, length and head circumference were found with moderate to low evidence following individualized compared to standard non-individualized fortification [ 35 ]. In 2021, a double-blind, randomized controlled trial was conducted in 103 preterm infants <30 weeks comparing standard versus targeted fortification with modular proteins, lipids, and carbohydrates [ 52 ].…”

Section: Fortificationmentioning

confidence: 99%

“…Fortify breastmilk to improve postnatal growth [ 2 , 34 ], consider adapted or individualized fortification to meet nutritional needs [ 35 ]…”

Section: Tablementioning

confidence: 99%

Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants

Wiechers

Bernhard

Goelz

et al. 2021

IJERPH

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Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks’ postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers’ own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.

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“…A recent systematic review evaluating growth outcomes following individualized fortification revealed stronger evidence for the growth benefits of adjustable versus targeted fortification based on available studies [72]. One study comparing targeted versus adjustable fortification strategies noted a greater daily increase in weight and head circumference in the targeted group, although a low BUN threshold (>5 mg/dL) was utilized in the adjustable fortification group [73].…”

Section: Individualized Fortificationmentioning

confidence: 99%

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

et al. 2021

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Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.

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Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk

Cited by 32 publications

References 57 publications

Optimising growth in very preterm infants: reviewing the evidence

Optimising growth in very preterm infants: reviewing the evidence

Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

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