Effects of human milk fortification on morbidity factors in very low birth weight infants

The use of human milk as a sole source of nutrients for preterm infants has been the subject of debate in recent years. We studied the morbidity factors associated with hospitalization of very low birth weight (VLBW) infants fed human milk with and without fortification.

One hundred VLBW infants were randomly assigned to two groups with stratification for gestation and weight. The control group (n-50; mean birth weight 1239+/-186 g and mean gestation 29.3+/-2.1 wks) was fed human milk only, and in the fortifier group (n=50; mean birth weight 1245+/-191 g and mean gestation 29.5+/-2.1 wks), human milk was enriched with a fortifier after the babies reached a volume of 140 mL/kg/day by the enteral route. Weight was measured twice weekly, biochemical indices of nutritional and bone status and serum electrolytes were obtained weekly, and clinical evidence for sepsis, necrotizing enterocolitis and feeding intolerance was assessed regularly until infants were discharged.

Hospital stay was less than 45 days in the majority (94%) of the babies in the fortifier group, whereas the majority (66%) of the babies in the control group stayed for more than 45 days (P<0.01). Low serum phosphorus and raised alkaline phosphate levels were seen more frequently in the control group without fortification (p<0.01), as weel as hyponatremia (P<0.01), late metabolic acidosis of prematurity (P<0.01) and culture-proven sepsis (p<0.05). There was no significant difference in the occurrence of necrotizing enterocolitis between the two groups (P>0.05).

Human milk fortification has beneficial effects on the growth of VLBW infants and decreases hospital stay and morbidity associated with prematurity and very low birth weight, with economic and psychological benefits for the parents.