Multi-nutrient fortification of human milk for preterm infants

Brown, Jennifer Valeska Elli; Lin, Luling; Embleton, Nicholas; Harding, Jane E; McGuire, William

doi:10.1002/14651858.cd000343.pub4

Cited by 45 publications

(52 citation statements)

References 87 publications

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“…Breast milk alone, even at an intake of 150 mL • kg −1 • d −1 , is not sufficient to meet the high requirements of essential nutrients in extremely preterm infants. Considering their high content of essential nutrients such as protein, calcium, and phosphate, the use of human milk-derived fortifiers (HMFs) has become the standard of care in the management of this cohort (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Human Milk–Derived Fortifiers Compared with Bovine Milk–Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis

Ananthan

Balasubramanian

Rao

et al. 2020

Advances in Nutrition

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This systematic review assessed outcomes after using human milk–derived fortifier (HMF) compared with bovine milk–derived fortifier (BMF) in preterm infants. Six randomized controlled trials (RCTs) were included. Meta-analysis using a random-effects model showed the following results: 1) lower risk of necrotizing enterocolitis (NEC; ≥Stage II) (RR: 0.38; 95% CI: 0.15, 0.95; P = 0.04, I2 = 9%; n = 334, 4 RCTs) and surgical NEC (RR: 0.13; 95% CI: 0.02, 0.67; P = 0.02, I2 = 0%; n = 209, 3 RCTs) in the HMF group; 2) no significant difference in mortality (RR: 0.40; 95% CI: 0.14, 1.15; P = 0.09, I2 = 0%; n = 334, 4 RCTs); 3) lower weight gain in the HMF group [mean difference (MD) = −1.08 g · kg−1 · d−1; 95% CI: −1.96, −0.21 g · kg−1 · d−1; P = 0.02, I2 = 0%; n = 241, 4 RCTs]; 4) no differences for length (MD = −0.11 cm/wk; 95% CI: −0.26, 0.04 cm/wk; P = 0.14, I2 = 68%) and head circumference (MD = −0.02 cm/wk; 95% CI: −0.08, 0.05 cm/wk; P = 0.59, I2 = 23%); and 5) no significant difference in late-onset sepsis (RR: 0.96; 95% CI: 0.56, 1.67; P = 0.90, I2 = 63%; n = 334, 4 RCTs). The beneficial effects of HMF for NEC were no longer significant in sensitivity analyses after excluding studies with high risk of bias. Quality of evidence as per Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis was low to very low, and hence the confidence in these results is low. In summary, fortification of milk in preterm infants with HMF compared with BMF decreased the risk of NEC but was associated with lower weight gain. Given the low quality of evidence, adequately powered and well-designed RCTs without the influence of industry are required in this field.

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Section: Introductionmentioning

confidence: 99%

Human Milk–Derived Fortifiers Compared with Bovine Milk–Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis

Ananthan

Balasubramanian

Rao

et al. 2020

Advances in Nutrition

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“…11 Slower growth rates, including that of the head circumference, have been observed in preterm babies fed only on human milk as compared with those on fortified human milk. 12…”

Section: Introductionmentioning

confidence: 99%

Preterm Nutrition and Clinical Outcomes

Gidi

Mekasha

Nigussie

et al. 2020

Global Pediatric Health

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Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.

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“…Available evidence, though limited, has shown that fortification of mother's milk results in short‐term growth in very low‐birth‐weight infants. An increase of the risk of necrotizing enterocolitis remains unclear . Earlier initiation may be well tolerated …”

Section: Discussionmentioning

confidence: 99%

“…An increase of the risk of necrotizing enterocolitis remains unclear. 33 Earlier initiation may be well tolerated. 34 There is a need for feeding regimens meeting the specific nutrition needs of LP infants.…”

Section: Effect Of Protein Intake On Weight Gain and Head Growth From Birth To Term Agementioning

confidence: 99%

“…34 Although optimizing protein intake has positive effects on growth in the short term, evidence is limited and long-term consequences are unclear. 33,36 Rapid "catch-up" growth is necessary for later neurodevelopment but is also associated with adverse health outcomes in later childhood and adulthood. These include obesity, hypertension, insulin resistance, and cardiovascular disease.…”

Section: Effect Of Protein Intake On Weight Gain and Head Growth From Birth To Term Agementioning

confidence: 99%

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Prescribed Protein Intake Does Not Meet Recommended Intake in Moderate‐ and Late‐Preterm Infants: Contribution to Weight Gain and Head Growth

2020

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Background The purpose of the study was to evaluate differences between prescribed and recommended protein intake in moderate‐preterm (MP) and late‐preterm (LP) infants and examine the contribution of the first week's prescribed protein intake to growth until term age. Methods Data on intake and anthropometrics were collected retrospectively in 235 preterm infants admitted to our general hospital's neonatal ward: 60 MP (320/7–336/7 weeks’ gestational age) and 175 LP (340/7–366/7 weeks’ gestational age). Differences between prescribed and recommended protein intake during the first postnatal week and z‐score change for weight and head circumference (HC) between birth and term age were calculated. Multiple regression was used to evaluate the independent contribution of first week's prescribed protein intake to growth until term age. Results At day 7, 58% of MP and 19% of LP infants reached recommended protein intake. At term age, mean z‐score change was −0.4 for weight and +0.1 for HC. Mean protein intake (g/kg/d) was associated with z‐score change of +0.34 (95% CI, 0.14–0.53; P < .001) for weight and +0.25 (95% CI, 0–0.5; P = .03) for HC. Reaching recommended protein intake at day 7 was only independently associated with weight z‐score change (+0.22 [95% CI, 0.04–0.41; P = .002]). Conclusion First week's prescribed protein intake does not meet recommended intake. Higher protein intakes in the first postnatal week result in increased weight gain and head growth until term age. Desirability and feasibility of increasing the protein intake need careful consideration and further discussion.

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Multi-nutrient fortification of human milk for preterm infants

Cited by 45 publications

References 87 publications

Human Milk–Derived Fortifiers Compared with Bovine Milk–Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis

Human Milk–Derived Fortifiers Compared with Bovine Milk–Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis

Preterm Nutrition and Clinical Outcomes

Prescribed Protein Intake Does Not Meet Recommended Intake in Moderate‐ and Late‐Preterm Infants: Contribution to Weight Gain and Head Growth

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