Early Human Milk Fortification in Infants Born Extremely Preterm: A Randomized Trial

Area of Science:

• Neonatal nutrition
• Pediatric growth and development
• Human milk fortifiers

Background:

• Preterm infants often experience protein and energy deficits with unfortified human milk.
• Early administration of fortified human milk may enhance fat-free mass (FFM) and overall growth.

Purpose of the Study:

• To evaluate the effect of early-fortified human milk on FFM accretion in extremely preterm infants.
• To assess the impact of fortified human milk on growth parameters up to 36 weeks postmenstrual age (PMA).

Main Methods:

• A masked, randomized trial involving extremely preterm infants (≤28 weeks gestation) fed maternal or donor milk.
• Infants received either fortified human milk (intervention) or standard unfortified milk (control) from feeding day 2 until a bovine-based fortifier was introduced.
• Primary outcome was FFM-for-age z score at 36 weeks PMA; secondary outcomes included length and head circumference growth velocities.

Main Results:

• No significant difference in FFM-for-age z scores at 36 weeks PMA between the fortified and unfortified groups.
• Higher length gain velocities were observed in the intervention group from birth to 36 weeks PMA.
• Less pronounced declines in head circumference-for-age z scores were noted in infants receiving fortified milk.

Conclusions:

• Early fortification of human milk does not significantly increase FFM in extremely preterm infants by 36 weeks PMA.
• Fortified human milk diets may promote improved linear growth (length) and preserve head growth in this population.
• These findings suggest potential benefits of early nutritional interventions for extremely preterm infants' development.