State of the evidence from clinical trials on human milk fortification for preterm infants*

Abstract

Preterm (born <37 weeks gestation) infants represent approximately 11% of births worldwide. 1 Survival for this population has improved owing to advancements in their medical care. However, they continue to face increased risk of mortality, morbidity including necrotising enterocolitis (NEC), sepsis, chronic lung disease or bronchopulmonary dysplasia, retinopathy of prematurity and later neurodevelopmental challenges. [2][3][4] Notably, infants born at very low birth weight (VLBW, <1500 g) are at the greatest risk. 3 Research supports the role of nutrition in improving outcomes of VLBW infants. Specifically, mother's milk provision is associated with reductions in NEC and sepsis and improves neurodevelopment. 5,6 However, human milk alone does not fulfil the increased nutritional requirements of VLBW infants, and multi-nutrient fortifiers are routinely used in a standardised, fixed amount in many parts of the world. Whilst evolving, the goal of providing nutrition

Issue highlights June 2022

“…Gridneva et al 3 describe environmental determinants of human milk composition in relation to health outcomes. Beggs et al 4 summarise the evidence from clinical trials on human milk fortification for preterm infants. Meanwhile, Picaud highlights the importance of donor human milk being available for very low‐birth weight infants 5 …”

Adjusted versus Targeted Fortification in Extremely Low Birth Weight Preterm Infants: Fortin Study. A Randomized Clinical Trial.

“…This is particularly true for extremely low birth weight (ELBW) infants due to their accelerated growth [1,[10][11][12][13]. The goal of fortification is to increase the nutrient concentration of human milk (HM) to the level required to optimize growth [8,[14][15][16][17][18][19].…”