Powdered human milk-derived versus bovine milk-derived breastmilk fortification: A multi-centre preterm randomised...

Area of Science:

• Neonatal nutrition
• Gastroenterology
• Pediatric clinical trials

Background:

• Preterm infants require specialized nutrition for optimal growth and development.
• Human milk is the preferred nutrition source, often supplemented with fortifiers.
• Comparing human milk-based fortifier (PHMF) and bovine milk-based fortifier (PBMF) is crucial for understanding their impact on infant gut health and growth.

Purpose of the Study:

• To compare the effects of PHMF versus PBMF on gut inflammation, plasma amino acids, and clinical outcomes in preterm infants on an exclusive human milk diet.
• To assess faecal calprotectin levels as a marker of gut inflammation.
• To evaluate growth and neonatal morbidities in response to different fortifier types.

Main Methods:

• A randomized controlled trial involving preterm infants (<32 weeks gestation or <1500g) receiving exclusive human milk and full enteral feeds.
• Primary outcome: faecal calprotectin within 21 days of starting fortification.
• Secondary outcomes: calprotectin at discharge, plasma amino acids, growth, and neonatal morbidities.

Main Results:

• The trial was terminated early due to the withdrawal of PHMF.
• No significant differences in faecal calprotectin levels were observed between PHMF and PBMF groups at Day 7, Day 21, or up to discharge.
• Infants receiving PHMF exhibited slower weight gain compared to those receiving PBMF, reaching statistical significance at discharge.

Conclusions:

• PHMF did not demonstrate a reduction in gut inflammation, as indicated by faecal calprotectin levels, compared to PBMF.
• Slower weight gain in the PHMF group suggests a potential clinical concern requiring further investigation.
• The study highlights the importance of monitoring growth alongside gut health markers when using different fortifier types in preterm infants.