Randomized Trial of Human Milk Cream as a Supplement to Standard Fortification of an Exclusive Human Milk-Based Diet in Infants 750-1250 g Birth Weight

Abstract

Premature infants who received HM-derived cream to fortified HM had improved weight and length velocity compared with the control group. HM-derived cream should be considered an adjunctive supplement to an exclusive HM-based diet to improve growth rates in premature infants.

Comparison of Calorie and Protein Intake of Very Low Birth Weight Infants Receiving Mother's Own Milk or Donor Milk When the Nutrient Composition of Human Milk Is Measured With a Breast Milk Analyzer

“…In this study, both DBM and MOM were lower in kcals/ounce at baseline than the standard value normally used in clinical practice of 20 kcals/ounce. This was similar to the findings by Hair et al who determined that the calorie content of HM from either source may be lower than assumed although in that study, DBM was higher in calories than MOM. de Halleux et al also compared the energy content of MOM and DBM and found that DBM from pooled donors provided less calories (63.6 ± 4.5 kcals/100 mL) than MOM (67.3 ± 6.5 kcals/100 mL), which is consistent with the findings of this study (60.6 ± 5.1 kcals/100 mL for DBM and 65.3 ± 13.2 kcals/100 mL for MOM), although their population of milk samples had higher overall calorie content when compared with the current study.…”

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

“…Decreased growth in infants supported with the EHM diet compared with a PTF diet has been reported in another study as well . Growth for infants receiving the EHM diet has been reported to be improved by fortifying breast milk at lower enteral feeding volumes than the previous practice of fortifying at 100 mL/kg/d of enteral feedings and by adding additional calories in the form of human milk cream when fortifying at ≤100 mL/kg/d …”

Human milk fortification strategies for improved in-hospital growth of preterm infants

“…A different approach to target fortification was reported by Hair et al 26 (Table 2) where fat was the only macronutrient added in addition to standard fortification. In this study a human milkderived fortifier and a human milk cream supplement were used to provide an exclusive human milk-based diet.…”

“…They differed in terms of birth weight of the participants, timing of standard fortification, total volume of human milk received, duration of study and type of fortifier and modular supplements used. Despite this heterogeneity, it seems noteworthy that the most promising results were seen in terms of improved growth in head circumference 20,[22][23][24] and length 22,23,26 , and primarily in the smaller, more immature 22,23 preterm infants. The significance of this needs to be investigated further because, firstly, head circumference and length may be indicators of growth in lean body mass and, secondly, the smaller, more immature preterm infants are also the most vulnerable to impaired neurocognitive development.…”

“…, Arslanoglu et al 24 and Hair et al 26 specified that no NEC was reported in the intervention groups in their respective studies; however, Kanmaz et al 20 reported NEC in one patient in the moderate fortification group. With the exception of increased serum urea levels in one study, 23 all changes in biochemical markers reported in the studies in Table 2, were not statistically significant.…”