Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet

Huston, Robert K.; Markell, Andrea M.; McCulley, Elizabeth A.; Gardiner, Stuart K.; Sweeney, Sean L.

doi:10.1002/ncp.10054

Cited by 26 publications

(43 citation statements)

References 26 publications

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“…This retrospective study found that fortification of human milk feedings with a human milk based fortifier at enteral feeding intakes <60 mL/kg/day compared to intakes of >60 mL/kg/day was associated with greater growth velocities and less negative changes in z-scores for weight and head circumference in infants <1250 g birth weight. Previous studies of infants receiving human milk fortified with human milk based fortifier found improved weight and length gain velocities associated with earlier fortification in a cohort study [ 5 ] as well as a retrospective study [ 4 ], although a randomized controlled study did not find a significant difference in growth velocities for infants fortified at lower versus higher enteral feeding volumes [ 1 ]. Studies of infants fortified at lower feeding volumes whose human milk was fortified with a bovine fortifier have not demonstrated improved growth in a retrospective study [ 7 ] and a randomized trial [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the bovine diet breast milk was also supplemented with a bovine-based fortifier. However, in some studies that reported growth, there has been decreased weight gain in infants supported with the EHM diet compared to a bovine diet [2,4]. Growth for infants receiving the EHM diet has been improved by fortifying breast milk earlier than the previous practice of fortifying at 100 mL/kg/day of enteral feeding volume [4][5] and by adding additional calories in the form of human milk cream when fortifying at less than or equal to 100 mL/kg/day [6].…”

Section: Introductionmentioning

confidence: 99%

“…However, in some studies that reported growth, there has been decreased weight gain in infants supported with the EHM diet compared to a bovine diet [ 2, 4 ]. Growth for infants receiving the EHM diet has been improved by fortifying breast milk earlier than the previous practice of fortifying at 100 mL/kg/day of enteral feeding volume [ 4-5 ] and by adding additional calories in the form of human milk cream when fortifying at less than or equal to 100 mL/kg/day [ 6 ]. Other studies have not found an improvement in growth parameters associated with earlier fortification of human milk feedings using a human milk based fortifier [ 1 ] or a bovine fortifier [ 7-8 ].…”

Section: Introductionmentioning

confidence: 99%

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Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

Huston

Lee²,

Rider

et al. 2020

NPM

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BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500-1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median ± IQR range for gestational age (27.6 ± 3.4 vs 27.0 ± 2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9 ± 2.6 vs 13.3 ± 2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

Huston

Lee²,

Rider

et al. 2020

NPM

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“…Macronutrient content and macronutrient-energy-ratios of HM, HM+HMF and HM+BMF are given in Table 1. Both groups received 6 mg/kg/d iron supplementation (Ferrum Hausman ® [iron-III-polymaltose-complex] or Aktiferrin ® [iron-II-sulfate] [16]) starting on the 15th day of life until discharge. The observation period ended at a gestational age of 37+0 weeks or discharge, whichever came first.…”

Section: Methodsmentioning

confidence: 99%

“…Based on available data, a sample size calculation was only possible for growth velocity from birth up to 37+0 weeks of gestation: 10% was considered as a minimally relevant effect, and a weighted mean of 13.35 and a weighted SD of 2.3 were derived for the HFM group from previous publications [16,26]. Thus, a sample size of 96 patients per group was sufficient to detect this effect with 90% power at a two-sided significance level of 1%.…”

Section: Methodsmentioning

confidence: 99%

Growth, Feeding Tolerance and Metabolism in Extreme Preterm Infants under an Exclusive Human Milk Diet

et al. 2019

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Background: For preterm infants, human milk (HM) has to be fortified to cover their enhanced nutritional requirements and establish adequate growth. Most HM fortifiers are based on bovine protein sources (BMF). An HM fortifier based on human protein sources (HMF) has become available in the last few years. The aim of this study is to investigate the impact of an HMF versus BMF on growth in extremely low birth weight (ELBW, <1000 g) infants. Methods: This was a retrospective, controlled, multicenter cohort study in infants with a birthweight below 1000 g. The HMF group received an exclusive HM diet up to 32+0 weeks of gestation and was changed to BMF afterwards. The BMF group received HM+BMF from fortifier introduction up to 37+0 weeks. Results: 192 extremely low birth weight (ELBW)-infants were included (HMF n = 96, BMF n = 96) in the study. After the introduction of fortification, growth velocity up to 32+0 weeks was significantly lower in the HMF group (16.5 g/kg/day) in comparison to the BMF group (18.9 g/kg/day, p = 0.009) whereas all other growth parameters did not differ from birth up to 37+0 weeks. Necrotizing enterocolitis (NEC) incidence was 10% in the HMF and 8% in the BMF group. Conclusion: Results from this study do not support the superiority of HFM over BMF in ELBW infants.

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Challenges in Implementing Exclusive Human Milk Diet to Extremely Low‐Birth‐Weight Infants in a Level III Neonatal Intensive Care Unit

et al. 2021

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Problem: Extremely low‐birth‐weight (ELBW) infants require fortification of human milk (HM) to prevent growth failure. Bovine milk–based fortifiers (BOV‐f) may be associated with feeding intolerance and necrotizing enterocolitis. Evidence suggests that an exclusive HM diet (EHMD) using HM‐based fortifier (HM‐f) may improve these outcomes. Intervention: EHMD was introduced as a quality improvement project to improve feeding tolerance in ELBW infants. Method: Implementation included establishing EHMD feeding protocol and growth monitoring. We compared infants receiving HM with BOV‐f (n = 49) with infants receiving an EHMD (n = 15). The primary outcome was a reduction of no oral intake days due to feeding intolerance. Results: The EHMD cohort had a more advanced GA (28 vs 26 weeks; P = .03), more males (66.7% vs 42.9%; P = .02), and higher incidence of SGA (40.0% vs 18.4%; P = .16) compared with the HM‐f group. The EHMD cohort had fewer days with no oral intake (2 vs 5; P < .005), which is insignificant when adjusted for small for gestational age (SGA) (P = .26). The EHMD cohort vs. the HM‐f cohort had a significant decrease in weight and length z‐scores from birth to discharge (−1.09 vs −0.26 [P = .002]; −1.76 vs −0.83 [P = .02]). Inadequate weight gain persisted after adjustment for SGA. Interventions were performed to increase caloric intake and institute milk preparation changes. Conclusion: EHMD improved feeding tolerance in our ELBW infants. Observed growth failure might be skewed by SGA prevalence. We highlight that implementation of EHMD requires close growth assessment, especially for SGA infants.

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Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet

Abstract: Implementation of a standardized feeding protocol including earlier fortification of maternal milk was associated with improved growth for infants receiving human milk feedings. EHM significantly decreased NEC. Earlier fortification had no effect on NEC.

Cited by 26 publications

References 26 publications

Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

Growth, Feeding Tolerance and Metabolism in Extreme Preterm Infants under an Exclusive Human Milk Diet

Challenges in Implementing Exclusive Human Milk Diet to Extremely Low‐Birth‐Weight Infants in a Level III Neonatal Intensive Care Unit

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