Optimizing individual nutrition in preterm very low birth weight infants: double-blinded randomized controlled trial

Brion, Luc P.; Rosenfeld, Charles R.; Heyne, Roy J.; Brown, L. Steven; Lair, Cheryl S.; Petrosyan, Elen; Jacob, Theresa; Caraig, Maria; Burchfield, Patti J.

doi:10.1038/s41372-020-0609-1

Cited by 20 publications

(19 citation statements)

References 41 publications

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“…These findings therefore support the concept that intervening with targeted human milk fortification of protein and energy may be an effective strategy to prevent nutrient deficits and improve physical growth, as previously proposed [38]. Thus far only a few clinical trials have examined the effectiveness of this approach [39][40][41][42][43]; results have been inconsistent regarding growth and data are lacking regarding brain development or neurodevelopmental outcomes.…”

Section: Discussionsupporting

confidence: 80%

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants

et al. 2020

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The variable macronutrient content of human milk may contribute to growth deficits among preterm infants in the neonatal intensive care unit (NICU). In a longitudinal study of 37 infants < 32 weeks gestation, we aimed to (1) determine the between-infant variation in macronutrient intake from human milk and (2) examine associations of macronutrient intake with growth outcomes. We analyzed 1626 human milk samples (median, 43 samples/infant) with mid infrared spectroscopy. Outcomes at term equivalent age were weight, length, head circumference, fat mass, and fat-free mass. Median (range) intakes from human milk were: protein 1.37 (0.88, 2.43) g/kg/day; fat 4.20 (3.19, 5.82) g/kg/day; carbohydrate 8.94 (7.72, 9.85) g/kg/day; and energy 82.5 (68.7, 99.3) kcal/kg/day. In median regression models adjusted for birth size and gestational age, and other covariates, greater intakes of fat and energy were associated with higher weight (0.61 z-scores per g/kg/day fat, 95% CI 0.21, 1.01; 0.69 z-scores per 10 kcal/kg/day, 95% CI 0.28, 1.10), whereas greater protein intake was associated with greater body length (0.84 z-scores per g/kg/day protein, 95% CI 0.09, 1.58). Higher fat intake was also associated with higher fat mass and fat-free mass. Macronutrient intakes from human milk were highly variable and associated with growth outcomes despite routine fortification.

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Section: Discussionsupporting

confidence: 80%

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants

et al. 2020

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“…This represents another reason for optimising protein intakes and protein-to-energy ratio. In summary, and in contrary to previously reported studies, the individualised nutritional care approach used in the present cohort helped limit postnatal growth deficits [32][33][34].…”

Section: Discussioncontrasting

confidence: 99%

Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study

et al. 2023

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This cohort study aimed to evaluate the impact of an individualised nutritional care approach combining standardised fortification with adjustable fortification on postnatal growth and body composition in extremely low birth weight (ELBW) infants. We included ELBW infants admitted to a neonatal intensive care unit and still hospitalised at 35 weeks postmenstrual age (PMA). The fortification of human milk was standardised (multicomponent fortifier) between 70 mL/kg/day and full enteral feeding, and then individualised using adjustable fortification. When weight gain was below 20 g/kg/day, protein or energy was added when serum urea was below or above 3.5 mmol/L, respectively. Postnatal growth failure (PNGF) was defined as being small for gestational age at discharge and/or when the Z-score loss between birth and discharge was higher than 1. Body composition was assessed between 35 and 41 weeks of PMA. Among the 310 ELBW infants included, the gestational age of birth was 26.7 ± 1.8 weeks, and the birth weight was 800 ± 128 g. The mean Z-score difference between birth and discharge was moderately negative for the weight (−0.32), more strongly negative for length (−1.21), and almost nil for head circumference (+ 0.03). Only 27% of infants presented PNGF. At discharge, fat mass was 19.8 ± 3.6%. Multivariable analysis showed that the proportion of preterm formula received and gestational age at birth were independently associated with the percentage of fat mass. Conclusion: The individualised nutritional care approach applied herein prevented postnatal weight loss in most infants, limited length growth deficit, and supported excellent head circumference growth. What is Known:• At least half of extremely low birth weight infants are small for gestational age at discharge and postnatal growth deficit has been associated with impaired neurocognitive and renal development.• Human milk is the main milk used in neonatology and, although fortification of human milk is a standard of care, there is no consensus regarding the optimal fortification strategy to be adopted. What is New:• Using an approach combining standardised fortification followed by individualised adjustable fortification limited postnatal growth deficit for body weight and head circumference. Postnatal growth failure is not a fatality in extremely low birth weight infants.• Each additional gestational age week at birth resulted in a decrease in fat mass percentage at discharge, which was higher than in foetuses of the same gestational age, likely representing a necessary adaptation to extra-uterine life.

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“…Supplementation is best done using targeted (individualized) fortification to aim for BUN >5 mg/dL (3.57 mmol/L) in order to improve linear growth. (22) In our study, despite no difference in the protein content of HMDF and CMDF, or total fluid per kg per day, infants with HMDF diet had a higher BUN and albumin. These results persisted before transition to bovine milk containing diet.…”

Section: Discussioncontrasting

confidence: 56%

Transient hypoglycemia and biochemical differences in infants less than 1250 grams at birth fed human milk with human milk-derived fortifier versus cow’s milk-derived fortifier

Chang

Tetarbe

Barton

et al. 2022

Preprint

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Objective: Fortification of human milk with either human milk-derived fortifier (HMDF) or cow’s milk-derived fortifier (CMDF) is important in preterm infants. Objective is to compare the incidence of hypoglycemia, and biochemical values in infants less than 1250g at birth fed HMDF versus CMDF. Study design: Retrospective cohort study on infants less than 1250g at birth who were fed with HMDF or CMDF. Results: Ninety infants were enrolled. HMDF group had a higher rate of hypoglycemia (46% vs.24%; p=0.048) after achievement of full enteral feeding. The median minimum blood glucose (BG) was lower (61 vs. 71; p=<0.01); while blood urea nitrogen (12 vs. 6; p=<0.01); and albumin (3.1 vs. 2.7; p=<0.01) were higher in HMDF group compared to CMDF. Conclusions: At full enteral feedings in infants less than 1250g at birth, an HMDF diet may predispose to hypoglycemia needing intervention. Close monitoring of BG levels once off parenteral nutrition is recommended.

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Optimizing individual nutrition in preterm very low birth weight infants: double-blinded randomized controlled trial

Cited by 20 publications

References 41 publications

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants

Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants

Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study

Transient hypoglycemia and biochemical differences in infants less than 1250 grams at birth fed human milk with human milk-derived fortifier versus cow’s milk-derived fortifier

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