Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier.

Publication Title

J Neonatal Perinatal Med

Authors

Robert Huston
Martin Lee
Evelyn Rider, Providence Alaska Medical Center, Anchorage, AK, USAFollow
Melissa Stawarz, Providence St. Vincent Medical Center, Portland, OR, USAFollow
Dawn Hedstrom
Melissa Pence
Vera Chan
Jessica Chambers, Providence Alaska Medical Center, Anchorage, AK, USA
Stefanie Rogers, Providence St. Vincent Medical Center, Portland, OR, USA.Follow
Nadine Sager
Laurie Riemann
Howard Cohen

Document Type

Article

Publication Date

1-1-2020

Keywords

alaska; anchorage; pamc; oregon; portland; psvmc

Abstract

BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet.

OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier.

STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500- 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus/kg/day (early) of enteral feeding volume.

RESULTS: Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification.

CONCLUSION: The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group.

Clinical Institute

Women & Children

Specialty/Research Institute

Perinatology/Neonatology