Home use of breast milk fortifier to promote postdischarge growth and breast feeding in preterm infants: a quality improvement project

Marino, Luise V.; Fudge, Carol; Pearson, Freya; Johnson, Michael E.

doi:10.1136/archdischild-2018-315951

Cited by 12 publications

(16 citation statements)

References 16 publications

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“…In accordance with this there have been recommendations that fortifier is continued in preterm breast fed babies either to term or around 52 weeks post conceptional according to their growth trajectory (103, 113). Although the practicality of putting this into practice has been questioned by some reviewers because of the availability of HMF in different countries and the perceived, but not proven, problems with practicability (106), evidence is accruing that it is possible using many different methods (114).…”

Section: Post Discharge Fortificationmentioning

confidence: 99%

Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification

et al. 2019

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Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that “Standard Fortification,” which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of “Individualized Fortification” to optimize nutrient intake. “Adjustable Fortification” and “Targeted Fortification” are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.

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Section: Post Discharge Fortificationmentioning

confidence: 99%

Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification

et al. 2019

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“…A longer response window or different method of distributing the survey may have elicited a higher response rate. A previous survey of the same specialist group had a higher response rate (66%) but a lower number of respondents ( n = 27) ( 13 ) . Previous studies on the use of BMF in other healthcare professionals have elicited a wide variation in response rates, from an exceptional online response rate of 98% ( 14 ) compared to 26% in a postal survey ( 15 ) .…”

Section: Discussionmentioning

confidence: 95%

“…Neither trial found a statistically significant difference in the overall duration of breastmilk feeding; however, one of the studies reported that statistically significantly fewer infants in the BMF group remained exclusively breastfed (no formula) at 4 months ( 33 ) . Subsequently, a UK‐based quality improvement study has demonstrated that the growth trajectory of exclusively breastfed preterm infants discharged home on BMF was improved up to 1 year of age, with parents and healthcare professionals finding the use of home BMF supplement to be acceptable, feasible and safe ( 13 ) . Overall, there is an absence of evidence on the effect of using BMF post‐discharge on long‐term growth and developmental outcomes beyond 1 year corrected age and it is recommended that any future interventions are developed in conjunction with families and consider the potential for interference on breastfeeding ( 34 ) .…”

Section: Discussionmentioning

confidence: 99%

“…In the UK, BMF is used as part of standard feeding practices in most neonatal units ( 7 ) . It is administered as a powder, mostly as a fixed dose sachet and available for inpatient use only ( 13 ) . Some specialist hospitals are equipped with human milk analysers, which can measure the exact nutritional composition of the breast milk given to infants.…”

Section: Introductionmentioning

confidence: 99%

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The use of Breast Milk Fortifier in Preterm Infants by paediatric dietitians in the UK

Jupe

Maslin

2020

J Human Nutrition Diet

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Background Breast milk is the feed of choice for premature infants, although its nutritional composition is not always sufficient to meet their raised nutritional requirements. The addition of a multi‐nutrient breast milk fortifier (BMF) to breastmilk is recommended; however, international guidelines on the use of BMF are inconsistent. The present study aimed to explore the use of BMF in preterm infants by paediatric dietitians in the UK. Methods A questionnaire was designed and sent to members of the British Dietetic Association neonatal specialist group (n = 100) using a secure online platform. Descriptive statistics were calculated. Results Forty dietitians completed the survey, all of whom used BMF. Local hospital BMF guidelines were available to 77.5% (n = 31). The most commonly used criteria for commencing BMF were: tolerating a feed volume of 150 mL kg−1 day−1 (72.5%, n = 29), a gestational age <34 weeks (67.5%, n = 27) and a birth weight <1500 g (60%, n = 24). The primary contraindication for the use of BMF was necrotising enterocolitis (NEC). The majority of respondents used standard fortification, with individualised fortification available to only 12.5% (n = 5). The most common indicators for discontinuing BMF were on discharge home (67.5%, n = 27), satisfactory growth (65%, n = 26) or feeding directly from the breast (62.5%, n = 25). Conclusions Although BMF is used more proactively in UK neonatal units than previously, variation in practice remains. Individualised fortification is very uncommon and caution remains regarding risk of NEC. The development of national guidelines on the use of BMF would help to standardise nutritional care in neonatal units.

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“…Seguindo a mesma linha raciocínio, de maneira geral, esse fator também é observado nos ganhos de peso e comprimento em bebês que se encontram em leite materno exclusivo, Toftlund et al (2018) apresenta em sua pesquisa dados de que crianças que amamentaram, apresentaram maior crescimento e peso entre a faixa etária de 3 a 6 anos. Da mesma forma que, em prematuros também observa-se esses ganhos, principalmente pela busca de compensar o quão imaturo o fisiológico se encontra (Halleux et al, 2019& Marino et al, 2019.…”

Section: Discussionunclassified

Por que amamentar?: Uma revisão de literatura

Caldas

Santos²,

Areia

et al. 2021

RSD

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O objetivo do estudo foi evidenciar os benefícios da amamentação para recém-nascidos prematuros. Trata-se de uma revisão integrativa da literatura, onde utilizou-se a Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scientific Electronic Library Online e Medical Literature Analysis and Retrievel System Online, com os Descritores em Ciências da Saúde (DECS) “Amamentação AND Crescimento e Desenvolvimento AND Prematuro”. Após aplicação dos critérios de inclusão e exclusão, utilizou-se o protocolo PRISMA para elucidação da seleção e uma tabela para evidenciar os 13 estudos escolhidos para compor a revisão. O prematuro deve receber como primeira e se possível, única escolha, o leite materno, pois este é suficiente para as necessidades do bebê, possuindo ainda, várias qualidades imunológicas, que irão auxiliar no crescimento, desenvolvimento e na imaturidade, proporciona ainda, diversos benefícios para mãe e filho, atuando sobre a saúde física, biológica e mental, mas transparece dificuldades enfrentadas para poder usufruir desses benefícios, como a amamentação exclusiva não ser frequentemente alcançada. Conclui-se que a amamentação deve ser muito bem orientada e estimulada para a sua implementação, pois acarreta benefícios para a mãe e para o bebê, auxiliando na bem-estar e na saúde física e mental dos dois.

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Home use of breast milk fortifier to promote postdischarge growth and breast feeding in preterm infants: a quality improvement project

Cited by 12 publications

References 16 publications

Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification

Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification

The use of Breast Milk Fortifier in Preterm Infants by paediatric dietitians in the UK

Por que amamentar?: Uma revisão de literatura

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