Early fortification of human milk versus late fortification to promote growth in preterm infants

Thanigainathan, Sivam; Abiramalatha, Thangaraj

doi:10.1002/14651858.cd013392.pub2

Cited by 21 publications

(15 citation statements)

References 34 publications

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“…Experts have recommended MM as the choice of feeding preterm infants, followed by pasteurized donor maternal milk (DM) and FM designed for preterm infants, and they have approved the use of human- or bovine-based milk fortifiers to meet their high nutrient needs [ 4 , 5 , 6 , 7 ]. However, there is insufficient evidence regarding the effect of fortification of milk on NEC development, with little or no effect for protection from this disease [ 3 , 4 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

et al. 2021

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(1) Background: The relationship between enteral nutrition and neonatal necrotizing enterocolitis (NEC) among premature neonates is still unclear. The present work was designed to assess the relationship between NEC and feeding strategies compared to control infants. (2) Methods: A retrospective case-control study of premature infants (<35 weeks’ gestation) with or without NEC that examined feeding practices and clinical characteristics at birth and 3, 7, and 14-day hospitalization, with a longitudinal and cross-sectional analysis. (3) Results: A total of 100 newborns with NEC diagnosis and 92 neonates without the disease with similar demographic and clinical characteristics were included. The median day of NEC diagnosis was 15 days (Interquartile Range (IQR) 5–25 days). A significantly higher number of neonates that were fasting on days 7 and 14 developed NEC (p < 0.05). In the longitudinal analysis, generalized linear and mixed models were fit to evaluate NEC association with feeding strategies and showed that exclusive mother’s own milk (MM) and fortified human milk (FHM) across time were significantly less likely associated with NEC (p < 0.001) and that enteral fasting was positively related with NEC. In the cross-sectional analysis, a binary logistic regression model was fit and predicted 80.7% of NEC cases. MM was also found to correlate with a reduced risk for NEC (OR 0.148, 95% CI 0.044–0.05, p = 0.02), and in particular, on day 14, several factors were related to a decreased odd for NEC, including birth weight, antenatal steroids, and the use of FHM (p < 0.001). (4) Conclusions: MM and FHM were associated with less NEC compared to fasting on days 7 and 14. Feeding practices in Neonatal Intensive Care Units (NICUs) should promote exclusive MM across the two-week critical period as a potential guideline to improve NEC outcome.

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Section: Introductionmentioning

confidence: 99%

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

et al. 2021

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“…Unfortunately, the optimal time point at which the fortifier should be added to human milk for promoting growth in preterm infants has not been decided yet. The common practice is to start fortification when the amount of breast milk reaches 100 mL/kg per day (19,23,24). However, in clinical scenario, fortification is delayed because of clinicians' concern about feed intolerance and the risk of NEC.…”

Section: Discussionmentioning

confidence: 99%

“…However, in clinical scenario, fortification is delayed because of clinicians' concern about feed intolerance and the risk of NEC. Thanigainathan et al (24) showed that early fortification of human milk (started at <100 mL/kg per day enteral feed volume or <7 days' postnatal age) compared to late fortification (started at ≥100 mL/kg per day feeds or ≥7 days postnatal age) may have little or no effect to promote growth in preterm infants. Further large-scale trials would be needed to determine the optimal time of fortification.…”

Section: Discussionmentioning

confidence: 99%

Screening of Serum Alkaline Phosphatase and Phosphate Helps Early Detection of Metabolic Bone Disease in Extremely Low Birth Weight Infants

et al. 2021

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Background: Extremely low birth weight (ELBW, <1,000 g) infants have a high risk of metabolic bone disease (MBD). Because of the late appearance of radiological signs, diagnosis of MBD in ELBW infants might be delayed, and its prevalence underestimated in this group of patients. This study adopted serial screening of serum alkaline phosphatase (ALP) and phosphate (P) of ELBW infants to determine whether such screening is helpful for the early detection of MBD.Materials and Methods: We performed a retrospective study of preterm infants with a gestational age ≤ 31 weeks and birth weight <1,000 g. MBD was absent (ALP ≤500 IU/L), mild (ALP >500 IU/L, P ≥4.5 mg/dL), and severe (ALP >500 IU/L, P <4.5 mg/dL); MBD was divided into early MBD (≤4 weeks after birth) and late MBD (>4 weeks after birth) according to the time of onset.Results: A total of 142 ELBW infants were included, with a median gestational age of 28.1 (26.5–29.7) weeks and a median birth weight of 875 (818–950) g. Seventy-three cases of MBD were diagnosed, and the total prevalence was 51.4% (mild MBD, 10.6%; and severe MBD, 40.8%). Male sex, breastfeeding, and sepsis would increase the risk of severe MBD. Most MBD in ELBW infants occurred at 3–4 weeks after birth. Sixty-two percent (45/73) of infants were diagnosed as having early MBD, which are diagnosed earlier than late MBD [24 (21–26) vs. 39 (36–41), t = −7.161; P < 0.001]. Male sex [odds ratio (OR), 2.86; 95% confidence interval (CI), 1.07–7.64; P = 0.036], initial high ALP levels (OR, 1.02; 95% CI, 1.01–1.03; P < 0.001), and breastfeeding (OR, 5.97; 95% CI, 1.01–25.12; P = 0.049) are independent risk factors for the development of early MBD.Conclusion: The risk of MBD among ELBW infants is very high. Most cases occurred early and were severe. Male sex, initial high ALP levels, and breastfeeding are closely related to the increased risk of early MBD. Serial screening of serum ALP and P helps early detection of MBD; it is recommended to start biochemical screening for ELBW infants 2 weeks after birth and monitor their biochemical markers weekly.

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“…However, the limited follow-up data for post-discharge growth and neurodevelopment in later childhood show no benefit from fortification [ 72 ]. A recent meta-analysis showed that early fortification starting at 20–40 mL/kg/d of enteral feeds vs. late fortification (starting at 100 mL/kg/d) had little or no effect on short-term growth outcomes [ 73 ].…”

Section: Fortificationmentioning

confidence: 99%

Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants

Wiechers

Bernhard

Goelz

et al. 2021

IJERPH

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Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks’ postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers’ own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.

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Early fortification of human milk versus late fortification to promote growth in preterm infants

Cited by 21 publications

References 34 publications

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices

Screening of Serum Alkaline Phosphatase and Phosphate Helps Early Detection of Metabolic Bone Disease in Extremely Low Birth Weight Infants

Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants

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