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Growth at 2 years corrected age in preterm infants discharged on two different breast milk enhancements: An
Brigitta Gehl1, Richard Feinn2, Kathleen Haines3
1Department of Pediatrics, New York Presbyterian-Columbia University, New York, New York, USA.
Insights
Breast milk fortification (BM-F) for preterm infants led to longer breast milk (BM) use and lower rates of overweight/obesity at 18-28 months corrected age. This approach impacts growth and long-term health outcomes in very low birth weight infants.
Area of Science:
- Neonatal Nutrition
- Pediatric Growth and Development
- Public Health
Background:
- Breast milk (BM) enhancement is crucial for meeting the nutritional needs of preterm infants post-discharge.
- Optimal growth in very preterm (VP) and very low birth weight (VLBW) infants is a key concern.
Purpose of the Study:
- To compare growth outcomes at 18-28 months corrected age (CA) in VP/VLBW infants based on two BM enhancement strategies.
- To evaluate the long-term effects of different post-discharge nutrition plans.
Main Methods:
- Retrospective chart review of 251 VP/VLBW infants born between 2013-2017.
- Comparison of infants discharged on fortified BM (BM-F) versus unfortified BM with formula feeds (BM-S).
- Propensity score matching and regression analysis to adjust for confounders.
Main Results:
- Infants on BM-F were more likely to continue BM use longer and had lower head circumference and weight-for-length z-scores.
- BM-F was associated with a higher incidence of moderate malnutrition.
- Discharge on BM-F significantly reduced the incidence of overweight/obesity at 18-28 months CA (OR 0.45, CI 0.21-0.96).
Conclusions:
- Post-discharge BM-F in VP/VLBW infants is linked to prolonged BM intake, altered growth parameters, and reduced overweight/obesity risk.
- Further research is needed on post-discharge nutrition's role in preterm children's growth, metabolic disease, and neurodevelopment.
Objective:
Breast milk (BM) enhancement is often used to meet the nutritional needs of preterm infants after hospital discharge to achieve optimal growth. This study compared growth at 18-28 months corrected age (CA) among very preterm (VP) and very low birth weight (VLBW) infants discharged from the neonatal intensive care units (NICUs) on two BM enhancements.
Methods:
We conducted a retrospective chart review study of infants born between January 1, 2013 and December 31, 2017, with gestational age < 32 weeks or birthweight < 1500 g, discharged from the NICU on BM enhancements; fortification of BM with infant formula additives (BM-F) or unfortified BM supplemented with bottle feeds of infant formula (BM-S). BM enhancements were nonrandomized and determined by the medical team. A linear mixed model regression analysis with propensity score matching was used to estimate the adjusted associations between the nutrition plan at discharge and growth outcomes at 18-28 months CA follow-up.
Results:
Two hundred and fifty-one VLBW/VP infants were included. Compared with BM-S, infants discharged on BM-F were more likely to continue receiving BM at 8-12 months CA, and had lower head circumference, weight-for-length z scores, and higher incidence of moderate malnutrition (p ≤ 0.01). After adjusting for confounders, discharge on BM-F was associated with a lower incidence of overweight/obesity at 18-28 months CA (odds interval: 0.45; confidence interval: 0.21-0.96; p = 0.04).
Conclusions:
This retrospective study suggests that VLBW/VP infants discharged on BM-F received BM longer, had lower growth parameter and were less likely to be overweight/obese at 18-28 months CA. Further studies are needed to evaluate the role of postdischarge nutrition on preterm born children's growth, metabolic disease, and neurodevelopmental outcomes.
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