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Hindmilk as a Rescue Therapy in Very Preterm Infants with Suboptimal Growth Velocity
Belal N Alshaikh1,2,3, Jannette Festival4, Adriana Reyes Loredo1,5
1Neonatal Gastroenterology and Nutrition Program, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T2N2T9, Canada.
Insights
Hindmilk, the nutrient-rich milk at the end of breast expression, significantly improved weight gain and head circumference in very preterm infants. This intervention also increased essential fatty acids, linoleic acid (LA) and alpha-linolenic acid (ALA).
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Biochemistry
Background:
- Very preterm infants (<30 weeks' gestation) often experience extrauterine growth faltering despite nutritional support.
- Optimizing energy and protein intake alone may not be sufficient for adequate growth in these vulnerable infants.
Purpose of the Study:
- To investigate the impact of hindmilk on growth parameters and plasma fatty acid profiles in very preterm infants with suboptimal growth.
- To assess changes in weight, head circumference, and specific fatty acids after incorporating hindmilk into the feeding regimen.
Main Methods:
- Prospective study involving 34 very preterm infants (<30 weeks' gestation) receiving hindmilk for two weeks.
- Assessment of weight, head circumference, and plasma fatty acids (FAs) before and after the intervention.
- Statistical analysis using paired t-tests and multiple linear regression.
Main Results:
- Significant increase in daily weight gain (3.9 g/kg/day) and improved weight Z-scores post-hindmilk feeding.
- Enhanced head circumference Z-scores observed from week three onwards.
- Elevated plasma levels of linoleic acid (LA) and alpha-linolenic acid (ALA) following hindmilk supplementation.
Conclusions:
- Hindmilk supplementation may be a beneficial strategy to improve growth and increase essential fatty acids in very preterm infants with faltering growth.
- Further validation through large-scale randomized controlled trials is warranted to confirm these findings.
Abstract:
Despite advances in neonatal nutrition, very preterm infants remain at increased risk of extrauterine growth faltering. This prospective study aimed to examine the effect of hindmilk, the milk at the end of a breast expression session, on growth and plasma fatty acids (FAs) of infants born <30 weeks' gestation who had been on full enteral feeds for ≥2 weeks and had a weight gain of <15 g/kg/day despite optimizing energy and protein intakes. Weight and plasma FAs were assessed before and two weeks after feeding hindmilk. Growth anthropometrics were assessed weekly for four weeks. Paired t-tests and multiple linear regression were used for statistical analyses of data from 34 infants and their 29 mothers. There was a significant increase in weight gain in the two weeks after feeding hindmilk (MD 3.9, 95%CI 1.2-6.5 g/kg/day). Weight Z-scores were larger at two weeks (MD 0.61, 95%CI 0.02-1.20) and onwards. Head circumference Z-scores were larger at three weeks (MD 0.83, 95%CI 0.20-1.47) and onwards. Plasma linoleic acid (LA) and α-linolenic acid (ALA) increased after feeding hindmilk. In conclusion, hindmilk may improve weight and head growth and increase LA and ALA in very preterm infants with suboptimal growth. A large randomized controlled trial is required to examine and validate the potential benefits of hindmilk.
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