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State of the evidence from clinical trials on human milk fortification for preterm infants
Megan R Beggs1, Nicole Bando1,2, Sharon Unger2,3
1Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Optimizing nutrition for preterm infants is crucial for growth and long-term health. Multi-nutrient fortification of human milk aids in-hospital growth, but long-term outcomes require further study.
Area of Science:
- Neonatal nutrition
- Pediatric growth and development
- Clinical nutrition
Background:
- Preterm and low birth weight infants face risks of morbidity, mortality, and neurodevelopmental impairment.
- Early postnatal growth is linked to improved in-hospital and post-discharge outcomes.
- Nutritional strategies supporting growth are vital for long-term health in this vulnerable population.
Purpose of the Study:
- To review the evidence on multi-nutrient fortification of human milk for preterm infants.
- To assess the impact of fortification on in-hospital growth and long-term neurodevelopmental outcomes.
- To identify gaps in current evidence regarding fortification practices.
Main Methods:
- Systematic review of randomized controlled trials.
- Analysis of data on in-hospital growth and neurodevelopmental outcomes.
- Evaluation of individualized versus standard fortification approaches.
Main Results:
- Multi-nutrient fortification improves in-hospital growth in preterm infants.
- Data on long-term neurodevelopmental outcomes following fortification is lacking.
- Individualized fortification may offer growth benefits over standard methods.
Conclusions:
- While fortification enhances early growth, its impact on long-term clinical and neurodevelopmental outcomes remains unclear.
- Evidence is insufficient regarding the optimal timing of fortifier introduction and post-discharge fortification.
- Well-designed trials are urgently needed to evaluate the benefits, risks, and costs of infant milk fortification practices.
Abstract:
Infants born preterm or low birth weight are at risk for morbidity, mortality and later neuroimpairment. Appropriate early post-natal growth is associated with better outcomes in-hospital and post-discharge. Therefore, nutritional strategies that support growth may improve the long-term health of this population. Mother's milk with donor milk as a supplement are preferred sources of nutrition for these infants but may not always support growth, especially amongst infants born of very low birth weight (<1500 g) and or those with a major morbidity. Systematic reviews of randomised controlled trials to date demonstrate that multi-nutrient fortification of human milk improves in-hospital growth of preterm infants although data on long-term neurodevelopment are lacking. Further, individualised approaches to fortification based on milk analysis or the infant's metabolic response may improve growth over standard fortification. The evidence is insufficient to inform the timing of introducing fortifier, routine fortification of feeds post-discharge or routine use of fortifiers made from human instead of bovine milk. Importantly, there is insufficient data to determine if these fortification practices improve relevant clinical or neurodevelopmental outcomes. In sum, there is an urgent need for well-designed clinical trials to assess potential benefits and risks of fortification practices and at what cost.
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