Human Milk Feeding of Very Low Birth Weight Infants During Initial Hospitalization and After Discharge

O’Connor, Deborah L.; Merko, S; Brennan, Joan

doi:10.1097/00017285-200405000-00005

Cited by 6 publications

(8 citation statements)

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“…The goal in nourishing low birth weight (LBW) premature infants should be to minimize nutrient deficits, promptly address these deficits once identified, and avoid overnourishing or promoting postnatal growth acceleration once nutrient deficits have been corrected. The best practices for accomplishing this, particularly early after hospital discharge, have yet to be defined (1)(2)(3)(4)(5). Although feeding human milk (HM) to LBW infants is widely acknowledged as being superior to formula feeding (6), HM-fed infants often accrue the greatest nutritional deficits by hospital discharge (1)(2)(3)(4)(5)7).…”

mentioning

confidence: 99%

Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1‐year Follow‐up

Aimone

Rovet

Ward

et al. 2009

J. pediatr. gastroenterol. nutr.

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mentioning

confidence: 99%

Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1‐year Follow‐up

Aimone

Rovet

Ward

et al. 2009

J. pediatr. gastroenterol. nutr.

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“…The recommended length of time to continue nutritional fortification and/or supplementation is difficult to generalize. When making the decision, consider (a) recovery from EUGR, (b) normalization of laboratory measures, (c) achievement of term-corrected age, and/or (d) passage of 12 weeks, based on studies by O'Connor and colleagues [7][8][9][10] and the AAP guidelines. 5 Would the approaches outlined in this section and in Figure 1 work in your NICU?…”

Section: Ptdfmentioning

confidence: 99%

Managing the Human-Milk-Fed, Preterm, VLBW Infant at NICU Discharge

Groh-Wargo

Thompson

2014

ICAN: Infant, Child, & Adolescent Nutrition

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Preterm, very-low-birthweight (VLBW) infants are at high nutritional risk because of poor nutrient stores at birth, digestive and neurodevelopmental immaturity, and increased risk of medical and surgical complications. Human milk (HM) is the preferred feeding for nearly all newborns. It is easily digested, well absorbed, and decreases the risk of infection. To meet the nutritional needs of small babies, however, HM requires fortification. HM fortification is the accepted norm during neonatal intensive care unit (NICU) hospitalization. This article reviews how to manage the humanmilk-fed preterm VLBW infant at NICU discharge. Recent evidence suggests that HM alone after discharge may not replenish nutrient deficits accumulated during the hospital stay or sustain growth in the immediate follow-up period. Practitioners are challenged with devising nutritionally adequate diets that are practical and sustainable while preserving the HM supply and protecting the breastfeeding experience. We will review the available science; reveal pitfalls in common practices, including "the sprinkles dilemma"; and present several options for regimens that meet nutritional goals.

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“…Importantly, there was a higher incidence of NEC among infants with birth weights < 2500 g and fed formula versus those fed donor milk (relative risk of 2.5 [95% CI, 1.2, 5.1]). Because NEC is the most common gastrointestinal emergency among VLBW infants, its prevention is a powerful argument in favor of donor milk as an alternative supplement to formula when mother’s own milk is not available [ 23 ]. NEC may lead to perforation of the bowel, bowel resection and death or long-term feeding problems associated with a shortened gastrointestinal tract [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Because NEC is the most common gastrointestinal emergency among VLBW infants, its prevention is a powerful argument in favor of donor milk as an alternative supplement to formula when mother’s own milk is not available [ 23 ]. NEC may lead to perforation of the bowel, bowel resection and death or long-term feeding problems associated with a shortened gastrointestinal tract [ 23 ]. Further, NEC, particularly surgical NEC has been shown to be associated with adverse neurodevelopment outcomes at 18–24 months CA [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Quigley et al review and meta-analysis, however, concluded that infants fed donor milk experienced slower weight ( p < 0.0001), length ( p < 0.0003) and head circumference ( p < 0.0001) gains than those fed formula. These risks associated with donor milk are of significant concern because VLBW infants are born with impoverished nutrient reserves, and are subject to metabolic stresses that further elevate nutritional requirements [ 22 , 23 ]. Nutrient deficits and sub-optimal growth has significant long term neurodevelopmental consequences [ 2 , 23 , 24 , 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

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DoMINO: Donor milk for improved neurodevelopmental outcomes

et al. 2014

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BackgroundProvision of mother’s own milk is the optimal way to feed infants, including very low birth weight infants (VLBW, <1500 g). Importantly for VLBW infants, who are at elevated risk of neurologic sequelae, mother’s own milk has been shown to enhance neurocognitive development. Unfortunately, the majority of mothers of VLBW infants are unable to provide an adequate supply of milk and thus supplementation with formula or donor milk is necessary. Given the association between mother’s own milk and neurodevelopment, it is important to ascertain whether provision of human donor milk as a supplement may yield superior neurodevelopmental outcomes compared to formula.Our primary hypothesis is that VLBW infants fed pasteurized donor milk compared to preterm formula as a supplement to mother’s own milk for 90 days or until hospital discharge, whichever comes first, will have an improved cognitive outcome as measured at 18 months corrected age on the Bayley Scales of Infant Development, 3rd ed. Secondary hypotheses are that the use of pasteurized donor milk will: (1) reduce a composite of death and serious morbidity; (2) support growth; and (3) improve language and motor development. Exploratory research questions include: Will use of pasteurized donor milk: (1) influence feeding tolerance and nutrient intake (2) have an acceptable cost effectiveness from a comprehensive societal perspective?Methods/DesignDoMINO is a multi-centre, intent-to-treat, double blinded, randomized control trial. VLBW infants (n = 363) were randomized within four days of birth to either (1) pasteurized donor milk or (2) preterm formula whenever mother’s own milk was unavailable. Study recruitment began in October 2010 and was completed in December 2012. The 90 day feeding intervention is complete and long-term follow-up is underway.DiscussionPreterm birth and its complications are a leading cause long-term morbidity among Canadian children. Strategies to mitigate this risk are urgently required. As mother’s own milk has been shown to improve neurodevelopment, it is essential to ascertain whether pasteurized donor milk will confer the same advantage over formula without undue risks and at acceptable costs. Knowledge translation from this trial will be pivotal in setting donor milk policy in Canada and beyond.Trial registrationISRCTN35317141; Registered 10 August 2010.

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Human Milk Feeding of Very Low Birth Weight Infants During Initial Hospitalization and After Discharge

Cited by 6 publications

References 45 publications

Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1‐year Follow‐up

Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1‐year Follow‐up

Managing the Human-Milk-Fed, Preterm, VLBW Infant at NICU Discharge

DoMINO: Donor milk for improved neurodevelopmental outcomes

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