Association of metabolic acidosis with bovine milk-based human milk fortifiers

Cibulskis, Catherine C.; Armbrecht, Eric S.

doi:10.1038/jp.2014.143

Cited by 26 publications

(38 citation statements)

References 26 publications

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“…Recent reports have suggested that use of acidified liquid HMF is associated with development of metabolic acidosis. 7 However, this report does not specify whether this is an anion gap or normal anion gap acidosis. These formulations predominantly contain hydrolyzed whey protein, which results in a more acidic solution (pH 4.7) versus powdered fortifier (pH 6.8); therefore, one could speculate that the acidification of this product would likely result in an anion gap acidosis.…”

Section: Discussionmentioning

confidence: 96%

Metabolic Acidosis with Ophthalmic Dorzolamide in a Neonate

Capino

Dannaway

Miller

2016

The Journal of Pediatric Pharmacology and Therapeutics

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Carbonic anhydrase inhibitors are a common cause of normal anion gap metabolic acidosis; however, development is less commonly associated with ophthalmic administration of these agents. We report a case of a premature neonate who was being treated at our institution with betaxolol, dorzolamide, and latanoprost ophthalmic products for suspected bilateral congenital glaucoma. In addition, the patient was also receiving caffeine, ursodiol, and acidified liquid human milk fortifier. The patient developed a normal anion gap metabolic acidosis, and both dorzolamide ophthalmic solution and the acidified human milk fortifier were considered potential causes. Upon discontinuation of the dorzolamide ophthalmic solution and the switching of liquid human milk fortifiers, the normal anion gap metabolic acidosis gradually resolved. As a result of the pH and acidity, the acidified liquid human milk fortifier is thought to be associated with an anion gap acidosis; therefore, dorzolamide is suspected to be the primary cause of a normal gap acidosis. This case demonstrates that systemic effects can occur with ophthalmic administration of dorzolamide in a premature neonate. Ophthalmic agents should not be overlooked as a potential cause of systemic toxicity.

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Section: Discussionmentioning

confidence: 96%

Metabolic Acidosis with Ophthalmic Dorzolamide in a Neonate

Capino

Dannaway

Miller

2016

The Journal of Pediatric Pharmacology and Therapeutics

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“…In preterm infants the kidney may not tolerate an acid load, leading to the development of metabolic acidosis. In a recent study, a liquid acidified HMF caused metabolic acidosis and poor growth in preterm infants in the NICU (17,18). In another study, Rochow et al (19) described a commercially available fortifier in Europe that had to be reformulated because of the development of metabolic acidosis from an imbalance of electrolytes.…”

Section: Discussionmentioning

confidence: 99%

Growth and Tolerance of Preterm Infants Fed a New Extensively Hydrolyzed Liquid Human Milk Fortifier

2016

J. pediatr. gastroenterol. nutr.

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Objectives: This study was a comparison of growth and tolerance in premature infants fed either standard powdered human milk fortifier (HMF) or a newly formulated concentrated liquid that contained extensively hydrolyzed protein.Methods: This was an unblinded randomized controlled multicenter noninferiority study on preterm infants receiving human milk (HM) supplemented with 2 randomly assigned HMFs, either concentrated liquid HMF containing extensively hydrolyzed protein (LE-HMF) or a powdered intact protein HMF (PI-HMF) as the control. The study population consisted of preterm infants 33 weeks who were enterally fed HM. Infants were studied from the first day of HM fortification until day 29 or hospital discharge, whichever came first. Results: A total of 147 preterm infants were enrolled. Noninferiority was observed in weight gain reported in the intent-to-treat (ITT) analysis was 18.2 and 17.5 g Á kg À1 Á day À1 for the LE-HMF and PI-HMF groups, respectively. In an a priori defined subgroup of strict protocol followers (n ¼ 75), the infants fed LE-HMF achieved greater weight over time than those fed PI-HMF (P ¼ 0.036). The LE-HMF group achieved greater linear growth over time compared to the PI-HMF (P ¼ 0.029). The protein intake from fortified HM was significantly higher in the LE-HMF group compared with the PI-HMF group (3.9 vs 3.3 g Á kg À1 Á day À1, P < 0.0001). Both fortifiers were well tolerated with no significant differences in overall morbidity. Conclusions: Both fortifiers showed excellent weight gain (grams per kilograms per day), tolerance, and low incidence of morbidity outcomes with the infants who were strict protocol followers fed LE-HMF having improved growth during the study. These data point to the safety and suitability of this new concentrated liquid HMF (LE-HMF) in preterm infants. Growth with this fortifier closely matches the recent recommendations for a weight gain of >18 g Á kg À1 Á day À1 .

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“…The laboratory values that were obtained are depicted below in Table 1. As already stated in the article, 6 there was no feeding protocol in place at the time periods included in the study, and we acknowledge that differences in inter-physician care may certainly affect the results. As noted in the article, there were no major changes in feeding practices, medications or policies in our neonatal intensive-care unit (NICU) in the time span data were collected.…”

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confidence: 92%

“…6 We were unable to determine whether the increased rate of metabolic acidosis was due to the additional protein load or due to the acidification of the liquid HMF that was performed to help achieve sterility. 7 In our NICU, we have since switched products to a non-acidified liquid HMF and supplementation with a liquid hydrolyzed protein in at-risk patients (ELBW infants, those with protein intake o 3.5 g kg − 1 per day despite fortification, those with poor growth or those with hypoalbuminemia).…”

mentioning

confidence: 99%

“…Unfortunately, this study was only conceived after we noticed we were having complications with the new liquid human milk fortifier (HMF), and therefore could not be performed as a prospective randomized trial. 6 Included in the limitations of a retrospective chart review, the only data that could be abstracted was that which had been obtained as clinically indicated at the time. This means that there were no guidelines in place for when to draw laboratory values or when to discontinue HMF.…”

mentioning

confidence: 99%

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