Is early breast milk fortification more effective in preterm infants?: a clinical trial

Abstract

Our findings suggest that early fortification from the first feeding in neonates with exclusive breast feeding did not improve growth in the first 4 weeks in preterm neonates in comparison with late fortification; so early fortification may not be cost effective.

Does early compared to late fortification of human milk for preterm infants improve clinical outcomes?

“…), duration of parenteral nutrition, growth at 34 weeks and bone mineral status throughout hospitalisation and description of nutritional intakes and growth outcomes between two cohorts after changes in practice . The authors of these studies consistently suggest that there is no increased risk of adverse effects with early fortification of human breast milk, although Tillman demonstrated a 32% lower risk of having the adverse event of blood in stools in the late fortification group, and both cases of necrotising enterocolitis (NEC) reported in the study conducted by Taheri et al . developed in infants receiving early fortification.…”

“…This systematic review did not identify any study that found a difference in growth outcomes or incidence of adverse events. Our study provides an updated review of the available literature, with two studies that we have identified being published after this review's literature searches were completed.…”

“…This review identified five full‐text primary studies relating to early versus late fortification of human milk . (Table ).…”

“…(Table ). Three were randomised controlled trials, two with limited follow‐up periods and small sample sizes . One looked at early versus late fortification as a secondary outcome only and instead focused on comparing an exclusive breast milk‐based diet with a diet of breast milk‐ and bovine milk‐based products .…”

“…Two were retrospective cohort studies, looking at outcomes before and after a feeding practice change . There was a wide variation in the definition of early fortification from the time of first feed, with a total volume of 25 mL, 20 mL/kg/day and 40 mL/kg/day . The definition of late fortification was more consistent, with three studies using 100 mL/kg/day and the other two ranging between 50 and 80 mL/kg/day .…”