Adjustable fortification of human milk fed to preterm infants

Cooke, R. J.

doi:10.1038/sj.jp.7211576

Cited by 22 publications

(8 citation statements)

References 17 publications

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“…Our study showed no significant differences in the postnatal growth of premature infants who received supplemental enteral protein when compared to the infants who received standard premature milk mixtures. The results of this study are not congruent with the findings of other recent research in which increased enteral protein intake significantly improved weight gains when compared to standard enteral protein intake [9,12,13,[21][22][23][24][25][26][27][28][29][30].…”

Section: Discussioncontrasting

confidence: 99%

Supplemental protein and postnatal growth of very low birth weight infants: A randomized trial

Ditzenberger

Wallen

Phelan

et al. 2013

Journal of Neonatal-Perinatal Medicine

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BACKGROUND: Providing adequate nutritional support to promote optimal postnatal growth for very low birth weight (VLBW) infants has been a difficult problem to surmount in the NICU. During the past 4 decades, improvements in neonatal critical care have made it possible for more VLBW infants to survive to discharge from NICUs. The NICHD Neonatal Network reported that while intrauterine growth restriction was present in 22% of VLBW infants at birth, 91% demonstrated postnatal growth restriction by 36 weeks post menstrual age. The persistence of this nearly universal growth deficit is associated with the inadequacy of protein and energy intake, which may account for 45-50% of the postnatal growth restriction. OBJECTIVE: The purpose of this study was to assess whether increasing enteral intake, using supplemental protein, would improve postnatal growth for VLBW infants. STUDY DESIGN: Randomized clinical trial. Sixty-four infants were enrolled (34 in control group with 15 infants <1000 g, and 30 in intervention group with 13 infants <1000 g). RESULT: There were no sustained statistical differences between weekly measurements of weight, length, head circumference, and skinfold thickness between groups. There were no significant differences between laboratory results except blood urea nitrogen at time of peak protein intake for intervention group. CONCLUSIONS: Supplemental enteral protein had minimal to no effect on postnatal weight, length, head circumference, body mass, or length of stay. It may be most important to provide consistent sustained nutritional support with protein from birth to reduce postnatal growth restriction, especially for those infants <1000 g at birth.

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Section: Discussioncontrasting

confidence: 99%

Supplemental protein and postnatal growth of very low birth weight infants: A randomized trial

Ditzenberger

Wallen

Phelan

et al. 2013

Journal of Neonatal-Perinatal Medicine

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“…Both individualization methods have been shown to be superior to standard fortification in terms of both weight gain and increases in head circumference . Adjustable fortification is considered practical and simple; it does not require analyses of breast milk, and the BUN level is frequently used as a valuable parameter in routine clinical practice . On the other hand, BUN analysis may not completely reflect the protein intake of VLBW infants, particularly in the first weeks of life .…”

Section: Discussionmentioning

confidence: 99%

Effects of Targeted Versus Adjustable Protein Fortification of Breast Milk on Early Growth in Very Low‐Birth‐Weight Preterm Infants: A Randomized Clinical Trial

et al. 2019

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Background Breast milk is preferred for the feeding of very low‐birth‐weight (VLBW) infants, but it does not meet nutrition requirements unless it is fortified. Adequate protein intake to maintain the growth of preterm infants cannot be provided by standard fortification methods because of variation in the protein content of human milk. Individualization is necessary to achieve target protein intakes. The goal of this study was to compare the effects of 2 different methods of individualized protein fortification of breast milk on the early growth of VLBW preterm infants. Methods In a prospective observational study, VLBW preterm infants ≤32 weeks of gestational age were randomized into 2 groups according to the method of breast milk fortification. Anthropometric measurements were performed in both groups weekly for 4 weeks to compare their growth. Results During the trial period, the daily protein intake (targeted vs adjustable fortification groups) was (median [range]) 4.5 (4.4–4.6) vs 4.01 (3.5–4.4) g/kg/d (P = 0.001); the daily weight gains (g/d and g/kg/d; mean ± SD) were 25.7 ± 3.9 vs 22.2 ± 6.4 g/d (P = 0.048) and 23.1 ± 4.3 vs 18.7 ± 4.3 g/kg/d (P = 0.014); and the weekly increase in head circumference was 9.8 ± 1.5 vs 8.4 ± 2.1 mm/wk (P = 0.040). All parameters were significantly higher in the targeted than the adjustable fortification group. Conclusions Individualized protein fortification using the targeted method for VLBW preterm infants had more positive effects on short‐term growth compared with the adjustable fortification method.

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“…9 At an intake of 3.0 g per 100 kcal, protein assimilation (2.7 g kg À1 per day) somewhat exceeded that 'in utero' (2.5 g kg À1 per day) and was paralleled by normal growth (27 g per day) and serum chemistries. 8,15 A further examination of the biochemical differences is therefore warranted. Statistically significant but small differences were noted in BUN, total protein, albumin, calcium and phosphorus levels between the groups.…”

Section: Discussionmentioning

confidence: 99%

Growth in preterm infants fed either a partially hydrolyzed whey or an intact casein/whey preterm infant formula

et al. 2008

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Objective: To compare feeding tolerance, nutrient intake and growth in preterm infants (p32 weeks, p1750 g) fed either a standard nonhydrolyzed whey-casein (nHWC) or a partially hydrolyzed whey (pHW) preterm infant formula.Study Design: In this double-blind randomized controlled trial infants were fed either formula for at least 3 weeks. Intake was monitored daily, serum chemistries and growth weekly. Data were analyzed using analysis of covariance.Result: A total of 80 infants were enrolled, 72 completed the study. No differences were noted in demographic characteristics. No differences were detected in feeding tolerance, intakes (118 ± 21 vs 119 ± 14; nHWC vs pHW) or growth weight, 28 ± 1.5 vs 28 ± 1.6 g per day; length, 1.0 ± 0.7 vs 1.0±0.6 cm per week; head circumference, 0.9±0.4 vs 1.0±0.44 cm per week). At the end of study, blood urea nitrogen (5.2 ± 3.1 <6.7±2.3 mg per 100 ml, nHWC4.4 ± 0.5 g per 100 ml) and albumin (2.7 ± 0.3 >2.6 ± 0.4 g per 100 ml) differed. Conclusion:A pHW preterm infant formula was not associated with improved feeding tolerance, enteral intake or growth but differences in serum chemistries. These are unlikely to be clinically relevant because values were well within normal limits for preterm infants, whereas growth was identical in both groups and paralleled that 'in utero'.

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Adjustable fortification of human milk fed to preterm infants

Abstract: In adults, as protein intake increases, so does blood urea nitrogen (BUN), unless significant protein accretion is occurring and/or hepatic function; that is urea synthetic capacity, is compromised.

Cited by 22 publications

References 17 publications

Supplemental protein and postnatal growth of very low birth weight infants: A randomized trial

Supplemental protein and postnatal growth of very low birth weight infants: A randomized trial

Effects of Targeted Versus Adjustable Protein Fortification of Breast Milk on Early Growth in Very Low‐Birth‐Weight Preterm Infants: A Randomized Clinical Trial

Growth in preterm infants fed either a partially hydrolyzed whey or an intact casein/whey preterm infant formula

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