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Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a
Chengsi Ong1, Anng Anng Wong2, Siew Tin Wong2
1Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore.
Insights
Enhanced fortification did not improve weight gain in very-low-birthweight (VLBW) infants but reduced declines in head circumference and linear growth compared to standard fortification.
Area of Science:
- Neonatal nutrition
- Pediatric growth studies
- Human milk fortification
Background:
- Pasteurized donor human milk (PDHM) fortification is crucial for very-low-birthweight (VLBW) infants.
- Standard fortification methods may be inadequate, leading to poorer growth outcomes.
- Enhanced fortification strategies are being explored to optimize VLBW infant growth.
Purpose of the Study:
- To compare the efficacy of an enhanced fortification (EF) method versus standard fortification (SF) for PDHM in VLBW infants.
- To assess the impact of EF on weight gain, linear growth, head circumference, and other clinical outcomes.
- To determine if EF can mitigate the growth deficits observed in VLBW infants receiving PDHM.
Main Methods:
- A randomized controlled trial involving VLBW infants in a neonatal intensive care unit.
- Infants were randomized to receive either SF (bovine HMF added to PDHM) or EF (high-fat PDHM with bovine HMF and liquid protein fortifier).
- Primary outcome was impaired weight gain; secondary outcomes included changes in length and head circumference z-scores, and rates of bronchopulmonary dysplasia and retinopathy of prematurity.
Main Results:
- No significant difference in impaired weight gain between the EF (73.3%) and SF (83.9%) groups.
- The EF group showed significantly smaller declines in length and head circumference z-scores compared to the SF group.
- The EF group required less high-calorie formula supplementation, but rates of bronchopulmonary dysplasia and retinopathy of prematurity were similar.
Conclusions:
- Enhanced fortification of PDHM did not improve weight gain in VLBW infants compared to standard fortification.
- EF demonstrated a benefit by reducing declines in head circumference and linear growth.
- Further research may optimize fortification strategies to improve overall growth outcomes for VLBW infants on PDHM.
Introduction:
Very-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.
Methods:
We designed a randomized controlled trial to determine whether an enhanced method of fortification (EF) improved growth in VLBW infants compared to standard fortification (SF). VLBW infants admitted to our tertiary-level neonatal intensive care unit were randomized to receive a bovine powdered human milk fortifier (HMF) added to PDHM (SF), or specially selected high-fat PDHM (fat concentration ≥3.8 g/dL) with bovine powdered HMF and a liquid protein fortifier providing an additional 0.67 g/dL protein (EF). Primary outcome was impaired weight gain defined as weight z-score drop of ≥0.8 from birth at 37 weeks or hospital discharge, whichever earlier. Secondary outcomes included change in length and head circumference (HC) z-scores from birth, requirement for high calorie formula, and rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP).
Results:
A total of 61 infants were randomized (31 SF, 30 EF). Impaired weight gain was not significantly different (SF 83.9% vs. EF 73.3%, p = 0.347), with similar declines in weight z-scores from birth in both groups SF -1.27 [interquartile range (IQR) -1.71, -0.87] vs. EF -1.13 (IQR -1.46, -0.78), p = 0.403. However, the EF group had a smaller decline in length and HC z-scores from birth to discharge compared to the SF group [Length z-score change: -0.92 (IQR -1.64, -0.48) vs. -1.64 (IQR -2.21, -0.89), p = 0.007; HC z-score change: -0.08 (IQR -0.74,0.58) vs. -0.86 (IQR -1.81, -0.21), p = 0.014]. The EF group also required less high calorie formula supplementation [0% (IQR 0-4.1) vs. 3.8% (IQR 0 -16.9), p = 0.032]. Rates of BPD and ROP were not significantly different between groups.
Conclusion:
Among VLBW infants, EF did not improve weight gain, but reduced declines in HC and linear growth compared to SF.
