Hindmilk as a Rescue Therapy in Very Preterm Infants with Suboptimal Growth Velocity

Abstract

Despite advances in neonatal nutrition, very preterm infants remain at increased risk of extrauterine growth faltering. This prospective study aimed to examine the effect of hindmilk, the milk at the end of a breast expression session, on growth and plasma fatty acids (FAs) of infants born <30 weeks’ gestation who had been on full enteral feeds for ≥2 weeks and had a weight gain of <15 g/kg/day despite optimizing energy and protein intakes. Weight and plasma FAs were assessed before and two weeks after feeding hindmilk. Growth anthropometrics were assessed weekly for four weeks. Paired t-tests and multiple linear regression were used for statistical analyses of data from 34 infants and their 29 mothers. There was a significant increase in weight gain in the two weeks after feeding hindmilk (MD 3.9, 95%CI 1.2–6.5 g/kg/day). Weight Z-scores were larger at two weeks (MD 0.61, 95%CI 0.02–1.20) and onwards. Head circumference Z-scores were larger at three weeks (MD 0.83, 95%CI 0.20–1.47) and onwards. Plasma linoleic acid (LA) and α-linolenic acid (ALA) increased after feeding hindmilk. In conclusion, hindmilk may improve weight and head growth and increase LA and ALA in very preterm infants with suboptimal growth. A large randomized controlled trial is required to examine and validate the potential benefits of hindmilk.

When did the substantial loss of child linear growth occur?

“…The deep attachment helps drain milk and ensure the infants get complete nutrition from hindmilk, the milk that is released at the end of the breastfeeding session as the breast empties [ 17 ]. Hindmilk provides higher fat and energy and could improve child growth [ 18 ]. However, in this study, due to the unavailability of the data, the quality of exclusive breastfeeding practices cannot be analyzed.…”

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

“…Although a third limitation could be the presented collected intake data on 3 days only, we have collected all days’ data of all 174 patients as is indicated in Table 3 and Table 4 . However, analysis among five GA groups of everyday nutritional data was shown to be impractical, not producing any significant results compared with the three different weeks comparisons (3, 7, and 14 days), which revealed important findings, the same way similar studies had analysed their data between only these three days contributing to the literature [ 68 , 69 ]. We best considered anthropometrics in evaluating preterm infants’ growth by calculating and using weight, length, and head circumference Δ z-scores.…”