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Early versus delayed introduction of human milk fortification in enterally fed preterm infants: A systematic review

Cathie Hilditch1,2,3,4, Amy Keir1,2,3,4, Carmel T Collins1,2

  • 1SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Journal of Paediatrics and Child Health
|October 20, 2021
PubMed

Insights

Introducing human milk fortification early or delayed in preterm infants showed no significant differences in necrotizing enterocolitis, sepsis, or feeding intolerance. The impact on infant growth remains uncertain due to very low-quality evidence.

Area of Science:

  • Neonatalogy
  • Pediatric Nutrition
  • Clinical Research

Background:

  • Preterm infants require specialized nutritional support.
  • Human milk fortification is crucial for growth and development.
  • Optimal timing for initiating fortification is debated.

Purpose of the Study:

  • To evaluate the effects of early versus delayed human milk fortification in preterm infants.
  • To compare adverse feeding outcomes and infant growth based on fortification timing.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials.
  • Searched major databases including Cochrane, MEDLINE, Embase, PubMed, and CINAHL.
  • Included three trials involving 378 preterm infants.

Main Results:

  • Compared fortification at ≤40 mL/kg/day versus ≥75 mL/kg/day.
  • Found little to no difference in necrotizing enterocolitis, sepsis, or feeding intolerance (low-quality evidence).
  • Infant growth showed no significant difference (very low-quality evidence).

Conclusions:

  • The optimal timing for human milk fortification in preterm infants is uncertain.
  • Early fortification (≤40 mL/kg/day) versus delayed (≥75 mL/kg/day) does not clearly improve growth or reduce adverse feeding outcomes.
  • Further high-quality research is needed to clarify the benefits of early fortification.
Abstract

Keywords:
breastmilkfortificationmeta-analysispreterm infantsystematic review

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