Prospective Comparison of Enfamil and Similac Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants

Kumar, Navin; Monga, Ranjan; Sampath, Venkatesh; Ehrhart, Barb

doi:10.1055/s-0037-1603940

Cited by 15 publications

(15 citation statements)

References 23 publications

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“…We did not consider here partially or extensively hydrolyzed fortifiers, now used in the United States. Such fortifiers have been compared with each other with some differences, [34][35][36][37] but not compared to HMDF for the broad range of morbidities differentially affected by CM versus HM exposure.…”

Section: Limitationsmentioning

confidence: 99%

Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk

Lucas

Boscardin

Abrams

2020

Breastfeeding Medicine

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Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death.

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Section: Limitationsmentioning

confidence: 99%

Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk

Lucas

Boscardin

Abrams

2020

Breastfeeding Medicine

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“…Two studies compared the different compositions of fortifiers [42,51]. Porcelli et al compared Wyeth Nutritional International's new HMF (test) with Enfamil HMF (reference); the authors reported an improvement in weight gain (19.7 vs. 16.8 g/kg/d, p = 0.04); however, no effect was observed on length gain [51].…”

Section: Different Formulasmentioning

confidence: 99%

“…This study also found a positive effect on feeding outcomes; mean human milk intake was higher in test HMF compared to reference HMF. Similarly, Kumar et al compared Similac liquid HMF with Enfamil liquid HMF [42]; the authors reported better weight gain among infants fed with Similac liquid HMF.…”

Section: Different Formulasmentioning

confidence: 99%

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Rana

McGrath²,

Gupta

et al. 2020

Nutrients

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(1) Introduction: Current evidence on managing infants under six months with growth failure or other nutrition-related risk is sparse and low quality. This review aims to inform research priorities to fill this evidence gap, focusing on breastfeeding practices. (2) Methods: We searched PubMed, CINAHL Plus, and Cochrane Library for studies on feeding interventions that aim to restore or improve the volume or quality of breastmilk and breastfeeding when breastfeeding practices are sub-optimal or prematurely stopped. We included studies from both low- and middle-income countries and high-income countries. (3) Results: Forty-seven studies met the inclusion criteria. Most were from high-income countries (n = 35, 74.5%) and included infants who were at risk of growth failure at birth (preterm infants/small for gestational age) and newborns with early growth faltering. Interventions included formula fortification or supplementation (n = 31, 66%), enteral feeds (n = 8, 17%), cup feeding (n = 2, 4.2%), and other (n = 6, 12.8%). Outcomes included anthropometric change (n = 40, 85.1%), reported feeding practices (n = 16, 34%), morbidity (n = 11, 23.4%), and mortality (n = 5, 10.6%). Of 31 studies that assessed formula fortification or supplementation, 30 reported anthropometric changes (n = 17 no effect, n = 9 positive, n = 4 mixed), seven morbidity (n = 3 no effect, n = 2 positive, n = 2 negative), five feeding (n = 2 positive, n = 2 no effect, n = 1 negative), and four mortality (n = 3 no effect, n = 1 negative). Of eight studies that assessed enteral feed interventions, seven reported anthropometric changes (n = 4 positive, n = 3 no effect), five feeding practices (n = 2 positive, n = 2 no effect, n = 1 negative), four morbidity (n = 4 no effect), and one reported mortality (n = 1 no effect). Overall, interventions with positive effects on feeding practices were cup feeding compared to bottle-feeding among preterm; nasogastric tube feed compared to bottle-feeding among low birth weight preterm; and early progressive feeding compared to delayed feeding among extremely low birth weight preterm. Bovine/cow milk feeding and high volume feeding interventions had an unfavourable effect, while electric breast pump and Galactagogue had a mixed effect. Regarding anthropometric outcomes, overall, macronutrient fortified formula, cream supplementation, and fortified human milk formula had a positive effect (weight gain) on preterm infants. Interventions comparing human breastmilk/donor milk with formula had mixed effects. Overall, only human milk compared to formula intervention had a positive effect on morbidity among preterm infants, while none of the interventions had any positive effect on mortality. Bovine/cow milk supplementation had unfavourable effects on both morbidity and mortality. (4) Conclusion: Future research should prioritise low- and middle-income countries, include infants presenting with growth failure in the post-neonatal period and record effects on morbidity and mortality outcomes.

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“…The use of acidified HMF in VLBW infants is controversial, showing no advantages in growth in most studies (33)(34). These include a relatively large multicenter randomized trial that found higher rates of metabolic acidosis in infants using an acidified LHMF (35).…”

Section: Discussionmentioning

confidence: 99%

Growth of Very Low Birth Weight Infants Who Received a Liquid Human Milk Fortifier

Masoli

Mena

Domínguez

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives:To evaluate growth (weight, length, head circumference, and knee–heel length [KHL]) in very low birth weight (VLBW) infants (500–1500 g) who received human milk with a liquid fortifier (LHMF) with high protein and fatty acid content versus a traditional powder fortifier (PHMF) for 45 days or until discharge.Methods:This was a multicenter, randomized, controlled trial. An intention-to-treat analysis was performed to determine adverse events and withdrawal causes. We also performed an efficacy analysis involving the infants who completed at least 2 weeks of study.Results:Of the 158 infants enrolled in the study, 146 completed at least 2 weeks, and 125 completed the entire study. The biodemographic characteristics were similar between groups, with no differences in increments of weight (22.9 vs 22.7 g kg−1 day−1), length (1.03 vs 1.09 cm/week), head circumference (0.91 vs 0.90 cm/week), or KHL (3.6 vs 3.3 mm/week). The KHL increment was greater in infants weighing >1 kg receiving LHMF (3.7 vs 3.2 mm/week, P = 0.027). Although there were no significant differences in serious adverse events, the incidence difference of the composite outcome death/necrotizing enterocolitis between groups warrants attention (1.3% with LHMF and 8.1% with PHMF).Conclusion:There were no differences in the overall growth between VLBW infants receiving either fortifier.

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Prospective Comparison of Enfamil and Similac Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants

Cited by 15 publications

References 23 publications

Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk

Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk

Feeding Interventions for Infants with Growth Failure in the First Six Months of Life: A Systematic Review

Growth of Very Low Birth Weight Infants Who Received a Liquid Human Milk Fortifier

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