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Early versus late fortification of breast milk in preterm infants: a systematic review and meta-analysis

Sriparna Basu1, Jaya Upadhyay2, Poonam Singh2

  • 1Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India. drsriparnabasu@rediffmail.com.

European Journal of Pediatrics
|May 28, 2020
PubMed

Insights

Early fortification of breast milk in preterm infants showed no significant impact on growth. However, early fortification was linked to longer hospital stays and a trend toward increased feed intolerance and necrotizing enterocolitis.

Area of Science:

  • Neonatal Nutrition
  • Pediatric Gastroenterology

Background:

  • Breast milk fortification is crucial for preterm infant nutrition.
  • Optimal timing for initiating breast milk fortification remains debated.

Purpose of the Study:

  • To compare the effects of early fortification (EF) versus late fortification (LF) of breast milk on preterm infant growth.
  • To evaluate adverse events and hospital stay duration associated with EF versus LF.

Main Methods:

  • Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
  • Included 3 trials with 309 preterm infants.
  • Data analyzed using RevMan 5.3; evidence quality assessed by GRADE.

Main Results:

  • No statistically significant differences in weight, length, or head circumference between EF and LF groups.
  • Total parenteral nutrition days were similar between groups.
  • Early fortification was associated with a significant increase in hospital stay (MD 4.29 days) and a non-significant trend towards increased feed intolerance and necrotizing enterocolitis (NEC).

Conclusions:

  • Very low-quality evidence indicates no significant difference in growth parameters between early and late breast milk fortification in preterm infants.
  • Early fortification may be associated with increased hospital stay and a potential trend towards higher rates of feed intolerance and NEC.

Keywords:
Breast milkEarlyGrowthHuman milk fortificationLateLow birth weight infantPreterm

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