[Multicenter study on the effects of human milk fortification in premature infants]

To study the effects of human milk fortification on growth and safety in premature infants in China during hospital stay.

A prospective controlled study was conducted in 4 tertiary hospitals in Beijing and Shanghai, premature infants born from Nov. 2009 to Mar. 2011 were included according to certain enrollment criteria. Premature infants were divided into two groups: fortified human milk group, i.e., FHM group who were fed with human milk over 50 percent during hospital stays, preterm formula was used for those whose mothers did not have enough milk, and preterm formula group as control who were fed fully with preterm formula. The enteral and parenteral nutritional intakes, complications and growth were compared between the two groups.

Among the 125 cases included, 62 were in the HMF group, and 63 were in the preterm formula group. Birth weight of HMF group (1429.1 ± 209.0) g was lower than that of the preterm formula group (1514.0 ± 210.5) g, there was no significant difference in gestational age, head circumference, length at birth, and correction gestational age at discharge, weight, head circumference and length at discharge, time for regaining birth weight, the mean daily protein, length of hospitalization between the two groups (P > 0.05). There was also no significant difference in the days for achieving total energy intake of 120 cal/(kg·d) and 150 ml/(kg·d) through enteral feeding between the two groups. The velocity of gaining weight, head circumference, and length after regaining birth weight 0.7 vs. 0.6 cm/W;1.1 vs. 0.9 cm/W were similar between the 2 groups. The biochemical parameters were similar at birth, but the serum urea nitrogen, prealbumin levels in FHM group were lower than those in the control group [(2.20 ± 1.17) vs. (2.66 ± 1.21) mmol/L (P = 0.036); (91.33 ± 21.21) vs. (107.0 ± 33.58) mg/L (P = 0.003)], while the calcium levels were higher than those of the control group [(2.48 ± 0.21) vs. (2.39 ± 0.15) mmol/L, P = 0.016]. Serum alkaline phosphatase and phosphor showed no significant difference [(2.01 ± 0.36) vs. (2.02 ± 0.42) mmol/L; (311.68 ± 142) vs. (284.67 ± 111) U/L]. Nosocomial infection in the FHM group was significantly lower than that in the control group [10 cases (16.1%) vs. 20 cases (31.7%), P = 0.021], there was no significant difference in incidence of feeding intolerance, necrotizing enterocolitis (NEC) between the two groups. The frequency and lasting time of feeding intolerance was obviously less in the FHM group than that in the control group.

Premature infants fed with fortified human milk showed similar growth pattern to those fed with preterm formula during hospital stay. FHM may decrease the incidence of nosocomial infection and feeding intolerance.