Fat supplementation of human milk for promoting growth in preterm infants

Amissah, Emma A; Brown, Julie; Harding, Jane E

doi:10.1002/14651858.cd000341.pub2

Cited by 37 publications

(16 citation statements)

References 45 publications

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“…Most current evidence is based on limited studies with low to medium study quality [14][15][16]18,19,21]. A review assessing the effect of cup feeding versus other forms of supplemental enteral feeding, for infants unable to fully breastfeed, reported similar findings as observed in our review [11].…”

Section: This Review's Findings In Contextsupporting

confidence: 77%

“…Many early-life interventions to improve growth among young infants have been tested, ranging from cup feeding to spoon-feeding to the fortification of either human/donor breastmilk or formula [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. However, currently, especially for infants who are already small or at-risk, there is insufficient data to develop recommendations [ 14 , 15 , 16 , 18 , 19 , 20 , 21 ]. In 2011 and 2013, WHO published recommendations on the feeding of LBW infants and management of severe acute malnutrition among infants <6 m, respectively; these recommendations were based on a limited and low or very low quality of evidence [ 8 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Rana

McGrath²,

Gupta

et al. 2020

Nutrients

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(1) Introduction: Current evidence on managing infants under six months with growth failure or other nutrition-related risk is sparse and low quality. This review aims to inform research priorities to fill this evidence gap, focusing on breastfeeding practices. (2) Methods: We searched PubMed, CINAHL Plus, and Cochrane Library for studies on feeding interventions that aim to restore or improve the volume or quality of breastmilk and breastfeeding when breastfeeding practices are sub-optimal or prematurely stopped. We included studies from both low- and middle-income countries and high-income countries. (3) Results: Forty-seven studies met the inclusion criteria. Most were from high-income countries (n = 35, 74.5%) and included infants who were at risk of growth failure at birth (preterm infants/small for gestational age) and newborns with early growth faltering. Interventions included formula fortification or supplementation (n = 31, 66%), enteral feeds (n = 8, 17%), cup feeding (n = 2, 4.2%), and other (n = 6, 12.8%). Outcomes included anthropometric change (n = 40, 85.1%), reported feeding practices (n = 16, 34%), morbidity (n = 11, 23.4%), and mortality (n = 5, 10.6%). Of 31 studies that assessed formula fortification or supplementation, 30 reported anthropometric changes (n = 17 no effect, n = 9 positive, n = 4 mixed), seven morbidity (n = 3 no effect, n = 2 positive, n = 2 negative), five feeding (n = 2 positive, n = 2 no effect, n = 1 negative), and four mortality (n = 3 no effect, n = 1 negative). Of eight studies that assessed enteral feed interventions, seven reported anthropometric changes (n = 4 positive, n = 3 no effect), five feeding practices (n = 2 positive, n = 2 no effect, n = 1 negative), four morbidity (n = 4 no effect), and one reported mortality (n = 1 no effect). Overall, interventions with positive effects on feeding practices were cup feeding compared to bottle-feeding among preterm; nasogastric tube feed compared to bottle-feeding among low birth weight preterm; and early progressive feeding compared to delayed feeding among extremely low birth weight preterm. Bovine/cow milk feeding and high volume feeding interventions had an unfavourable effect, while electric breast pump and Galactagogue had a mixed effect. Regarding anthropometric outcomes, overall, macronutrient fortified formula, cream supplementation, and fortified human milk formula had a positive effect (weight gain) on preterm infants. Interventions comparing human breastmilk/donor milk with formula had mixed effects. Overall, only human milk compared to formula intervention had a positive effect on morbidity among preterm infants, while none of the interventions had any positive effect on mortality. Bovine/cow milk supplementation had unfavourable effects on both morbidity and mortality. (4) Conclusion: Future research should prioritise low- and middle-income countries, include infants presenting with growth failure in the post-neonatal period and record effects on morbidity and mortality outcomes.

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Section: This Review's Findings In Contextsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Rana

McGrath²,

Gupta

et al. 2020

Nutrients

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“…This metaanalysis was done on formula fed infants. Formula fed infants were excluded in our study.An earlier study showed no effect on short term growth of preterm infants fed fat supplemented human milk [20]. Our study also shows similar growth in all study groups over the study period of 2 months.…”

Section: Discussionsupporting

confidence: 83%

To compare the efficacy of fortification of expressed breast milk with medium chain triglycerides and coconut oil on the physical growth of very low birth weight babies

Joshi

Jain

2018

Int J Pediatr Res

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Background: The most important factor leading to growth failure in VLBW babies is inadequate nutrition. Though, higher amounts of protein, sodium, chloride, and magnesium are available in preterm human milk than those found in term milk, these levels still remain below recommendations. To compensate these requirements, human milk for preterm infants is routinely fortified to increase energy, protein and mineral intake. In the past, very few studies have been done to find out the efficacy of medium chain triglycerides and coconut oil for fortification of human milk. Since, a major chunk of LBW babies exists in our country, this study is undertaken. Objectives: To study and compare the physical growth (weight, length and head circumference) over a period of two months in each study group. Design: Prospective cohort study. Setting: The study was conducted from April, 2015 to August, 2016 at Department of Pediatrics, MY hospital and CNBC, Indore. Participants: 225 VLBW babies (<1.5 kg) admitted in SCNU and postnatal wards. Intervention: The babies were assigned to group 1, 2 and 3 in serial order. Sample size in each group was 75. Group1-Given expressed breast milk with lactodex-HMF. Group 2-Given expressed breast milk with lactodex-HMF and MCT (Simyl MCT oil). Group 3-Given expressed breast milk with lactodex-HMF and coconut oil (Parachute-100% edible oil) Physical growth was monitored every week for 2 months. Results: Significant physical growth (weight, length and head circumference) was noticed in each of the study groups over 2 months (p value<0.05). There was no statistically significant difference in the physical growth between the groups (p>0.05). Conclusion: There is no advantage of MCT or coconut oil in addition to Lactodex-HMF on the physical growth of VLBW babies.

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“…Only one study reported on the sources of funding for the studies (Q10). 26 All reviews except one 25 reported potential sources of conlfict of interest. The only review that was not a Cochrane review had several methodological flaws which led to a critically low level of confidence in its findings.…”

Section: Methodological Quality Of the Included Reviewsmentioning

confidence: 99%

“…The review included 1 study with only 14 babies; there was no evidence that the addition of fat improved in-hospital growth or affected tolerance of feeds. 25 The quality of evidence was very low due to Open access incomplete description of the methodology and small sample size. A review that assessed the effect of supplementation of human milk with short-chain galacto-oligosaccharides/ long-chain fructo-oligosaccharides included 1 study with 75 participants.…”

Section: How To Advance Enteral Feedsmentioning

confidence: 99%

Evidence that informs feeding practices in very low birthweight and very preterm infants in sub-Saharan Africa: an overview of systematic reviews

Akindolire

Talbert

Sinha

et al. 2020

bmjpo

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BackgroundOptimal feeding of very low birthweight (VLBW <1500 g)/very preterm (gestation <32 weeks) infants in resource-limited settings in sub-Saharan Africa (sSA) is critical to reducing high mortality and poor outcomes.ObjectiveTo review evidence on feeding of VLBW/very preterm infants relevant to sSA.MethodsWe searched the Cochrane Database of Systematic Reviews, Embase, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to July 2019 to identify reviews of randomised and quasi-randomised controlled trials of feeding VLBW/very preterm infants. We focused on interventions that are readily available in sSA. Primary outcomes were weight gain during hospital stay and time to achieve full enteral feeds (120 mL/kg/day). Secondary outcomes were growth, common morbidities, mortality, duration of hospital stay and cognitive development. Quality of evidence (QOE) was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR2).ResultsEight systematic reviews were included. Higher feed volume of day 1 (80 mL/kg) reduced late-onset sepsis and time to full enteral feeds, and higher feed volume (up to 300 mL/kg/day) improved weight gain without adverse events (QOE: low–moderate). Rapid advancement of feeds (30–40 mL/kg/day) was not associated with harm. Breast milk fortification with energy and protein increased growth and with prebiotics increased growth and reduced duration of admission (QOE: low–very low) and did not result in harm. Evidence regarding feeding tube placement and continuous versus bolus feeds was insufficient to draw conclusions. We found no reviews meeting our selection criteria regarding when to start feeds, use of preterm formula, cup-and-spoon feeding or gravity versus push feeds and none of the reviews included trials from low-income countries of sSA.ConclusionsThe evidence base informing feeding of VLBW/very preterm babies in resource-limited settings in sSA is extremely limited. Pragmatic studies are needed to generate evidence to guide management and improve outcomes for these highly vulnerable infants.PROSPERO registration numberCRD42019140204.

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Fat supplementation of human milk for promoting growth in preterm infants

Abstract: Fat supplementation of human milk for promoting growth in preterm infants (Review)

Cited by 37 publications

References 45 publications

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

To compare the efficacy of fortification of expressed breast milk with medium chain triglycerides and coconut oil on the physical growth of very low birth weight babies

Evidence that informs feeding practices in very low birthweight and very preterm infants in sub-Saharan Africa: an overview of systematic reviews

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