Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: an Introduction of a Feeding Protocol in a University Hospital

Sakka, Abeer El; Shimi, Mohamed; Salama, Kareem; Fayez, Hend

doi:10.4081/pr.2016.6632

Cited by 11 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fortification of mother's milk was introduced in the 1990s to improve growth in VPI while supporting breastfeeding at the same time [18]. Arslanoglu et al [19] showed that protein enrichment increased growth in VPI up to 5 years of age.…”

Section: Discussionmentioning

confidence: 99%

Catch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children

Toftlund¹,

Halken²,

Agertoft³

et al. 2018

Neonatology

View full text Add to dashboard Cite

Background: Breastfeeding promotes healthy growth in very-preterm-born infants (VPI), but extra nutritional supply is needed to ensure catch-up growth and brain development. Objectives: To investigate how different types of post-discharge nutrition affect growth until 6 years of age in children born VPI. Methods: This was a 6-year follow-up study of 281 VPI. Median gestational age (GA) was 30 + 0 weeks (range 24–32 weeks). When breastfed at discharge, they were randomized to unfortified human milk (UHM) or fortified human milk (FHM). If not breastfed at discharge, they received a preterm formula (PF). The intervention lasted until 4 months of corrected age (CA). At 6 years CA, their height and weight were measured. Results: A total of 239 children participated in the follow-up. UHM-feeding compared to both PF- and FHM-feeding resulted in a slower but continuous catch-up growth until 6 years of age. Participants born small-for-GA compared to appropriate-for-GA more often demonstrated continuous catch-up growth until 6 years of age (p = 0.018). Rapid weight growth (a change in z score > 1 SD during a short time period) was found to be most pronounced from 34 weeks post-menstrual age to 2 months CA, and especially among those fed PF (p = 0.002 vs. UHM, p = 0.07 vs. FHM). Conclusions: Catch-up growth occurred mainly before discharge, regardless of the feeding group. UHM-fed infants demonstrated catch-up growth that was slower, but extended until 6 years of age. Rapid weight growth was most pronounced shortly after discharge and especially if PF-fed.

show abstract

Section: Discussionmentioning

confidence: 99%

Catch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children

Toftlund¹,

Halken²,

Agertoft³

et al. 2018

Neonatology

View full text Add to dashboard Cite

show abstract

“…The composition of the formulations used in the study was similar to other products available in the country (eTable 5 in Supplement 2). In contrast to the weight gain, the weekly length gain and head circumference growth in this study were comparable with that in the previous studies …”

Section: Discussionmentioning

confidence: 87%

“…In contrast to the weight gain, the weekly length gain and head circumference growth in this study were comparable with that in the previous studies. 10,20,21 Neonates in the PTF group had a significantly lower incidence of feed intolerance during the hospital stay (eTable 4 in Supplement 2). The proportion of neonates having 1 or more episodes of feed intolerance was also lower in the PTF group: 3% (n = 2) vs 14% (n = 9) (eTable 4 in Supplement 2).…”

Section: Discussionmentioning

confidence: 99%

“…9 We hypothesized that the fortification of EBM with the preterm formula (PTF) would be a safer, more economical, and possibly equally effective option. Although PTF fortification is done in some LMICs, 10 there is a paucity of evidence to recommend its routine use. Therefore, we planned this trial to demonstrate whether fortification of EBM using PTF is noninferior to fortification by using commercially available HMF.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates

et al. 2021

View full text Add to dashboard Cite

breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed intolerance limit their widespread use. Preterm formula powder fortification (PTF) might be a better alternative in resource-limited settings.OBJECTIVE To demonstrate that fortification of EBM by preterm formula powder is noninferior to fortification by HMF, in terms of short-term weight gain, in VLBW neonates.DESIGN, SETTING, AND PARTICIPANTS Open-label, noninferiority, randomized trial conducted from December 2017 to June 2019 at a level 3 neonatal unit in India. The trial enrolled preterm (born at or before 34 weeks of gestation) VLBW neonates receiving at least 100 mL/kg/d of feeds and consuming 75% of milk or more as EBM.INTERVENTIONS Neonates were randomly assigned to receive fortification by either PTF or HMF. Calcium, phosphorus, iron, vitamin D, and multivitamins were supplemented in PTF and only vitamin D in the HMF group to meet the recommended dietary allowances. MAIN OUTCOMES AND MEASURESThe primary outcome was the weight gain until discharge from the hospital or 40 weeks' postmenstrual age, whichever was earlier; the prespecified noninferiority margin was 2 g/kg/d. Secondary outcomes included morbidities such as necrotizing enterocolitis, feed intolerance, and extrauterine growth restriction (<10th percentile on the Fenton chart at 40 weeks' postmenstrual age). RESULTSOf the 123 neonates enrolled, 60 and 63 were randomized to the PTF and HMF groups, respectively. The mean gestation (30.5 vs 29.9 weeks) and birth weight (1161 vs 1119 g) were comparable between the groups. There was no difference in the mean (SD) weight gain between the PTF and HMF groups (15.7 [3.9] vs 16.3 [4.0] g/kg/d; mean difference, −0.5 g/kg/d; 95% CI, −1.9 to 0.7). The lower bound of 95% CI did not cross the noninferiority margin. The incidence of feed intolerance was lower in the PTF group (1.4 vs 6.8 per 1000 patient-days; incidence rate ratio 0.19; 95% CI, 0.04 to 0.95), and fewer neonates required withholding of fortification for 24 hours or more (5% vs 22%; risk ratio, 0.22; 95% CI, 0.07 to 0.75). The incidence of necrotizing enterocolitis stage II or more (0 vs 5%) and extrauterine growth restriction (73% vs 81%) was comparable between the groups.CONCLUSIONS AND RELEVANCE Fortification with preterm formula powder is not inferior to fortification with human milk fortifiers in preterm neonates. Given the possible reduction in feed intolerance and lower costs, preterm formula might be a better option for fortification, especially in resource-restricted settings.

show abstract

“…Breast milk alone is insufficient to support the growth of premature VLBWIs [ 14 ], but fortification improves their growth [ 16 ]. However, human milk fortifiers were not approved by the Jordan Food and Drug Administration; instead, breast milk was fortified using premature discharge formula, a practice documented before in our region [ 17 ]. Fortification was started once the infants reached full feeds.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Support of Very Low Birth Weight Infants in a Tertiary Center in a Developing Country

et al. 2019

View full text Add to dashboard Cite

BackgroundVery low birth weight infants (VLBWIs) are at high risk for nutritional deficiency. Enteral feeding is usually challenged by increased risk of necrotizing enterocolitis (NEC). The nutritional needs of VLBWIs are usually dependent on parenteral nutrition during early postnatal life. This study aimed to evaluate the nutritional service of VLBWIs at Jordan University Hospital.MethodsThis was a prospective follow-up study of VLBWIs with birth weight ≤ 1,500 g. Data were extracted from medical charts and laboratory database.ResultsIn total, 43 VLBWIs met our inclusion criteria; of them, 21% were extremely low birth weight infants (ELBWIs). The mean gestational age was 29 weeks, and the mean birth weight was 1,218 g. The mean age of starting feeds was 3 days. Mean full feed age is 2 weeks. The most common side effect of total parenteral nutrition (TPN) was hypertriglyceridemia (35%).ConclusionsNutritional care of VLBWIs is well established in our center. Initiating fortification earlier and working to increase mother’s own breast milk supply is vital to improve growth in low resource setting.

show abstract

Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: an Introduction of a Feeding Protocol in a University Hospital

Cited by 11 publications

References 16 publications

Catch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children

Catch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children

Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates

Nutritional Support of Very Low Birth Weight Infants in a Tertiary Center in a Developing Country

Contact Info

Product

Resources

About