Targeted or adjustable versus standard diet fortification for growth and development in very low birth weight infants receiving human milk

Fabrizio, Veronica; Trzaski, Jennifer; Brownell, Elizabeth A.; Esposito, Patricia; Lainwala, Shabnam; Lussier, Mary M.; Hagadorn, James I.

doi:10.1002/14651858.cd013465

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…A systematic review and meta-analysis by Fabrizio et al (42) determined that there was moderate-to low-certainty evidence supporting that individualized fortification (encompassing both targeted fortifications using HMA and adjustable fortification) for VLBW infants improved short-term growth compared to VLBW infants receiving standard fortification (42). Individual studies using HMA for targeted fortification have shown that this practice may improve growth and body composition outcomes (25,43), but this finding is not universal (44).…”

Section: Barrier 1: Who Should Receive Hma and Individualized Fortification And How Often?mentioning

confidence: 99%

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

et al. 2021

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Introduction: Human milk (HM) is the ideal enteral feeding for nearly all infants and offers unique benefits to the very low birthweight (VLBW) infant population. It is a challenge to meet the high nutrient requirements of VLBW infants due to the known variability of HM composition. Human milk analysis (HMA) assesses the composition of HM and allows for individualized fortification. Due to recent U.S. Food and Drug Administration (FDA) approval, it has relatively recent availability for clinical use in the US.Aim: To identify current practices of HMA and individualized fortification in neonatal intensive care units (NICUs) across the United States (US) and to inform future translational research efforts implementing this nutrition management method.Methods: An institutional review board (IRB) approved survey was created and collected data on the following subjects such as NICU demographics, feeding practices, HM usage, HM fortification practices, and HMA practices. It was distributed from 10/30–12/21/2020 via online pediatric nutrition groups and listservs selected to reach the intended audience of NICU dietitians and other clinical staff. Each response was assessed prior to inclusion, and descriptive analysis was performed.Results: About 225 survey responses were recorded during the survey period with 119 entries included in the analysis. This represented 36 states and Washington D.C., primarily from level III and IV NICUs. HMA was reported in 11.8% of responding NICUs. The most commonly owned technology for HMA is the Creamatocrit Plus TM (EKF Diagnostics), followed by the HM Analyzer by Miris (Uppsala, Sweden). In NICUs practicing HMA, 84.6% are doing so clinically.Discussion: Feeding guidelines and fortification of HM remain standard of care, and interest in HMA was common in this survey. Despite the interest, very few NICUs are performing HMA and individualized fortification. Barriers identified include determining who should receive individualized fortification and how often, collecting a representative sample, and the cost and personnel required.Conclusions: Human milk analysis and individualized fortification are emerging practices within NICUs in the US. Few are using it in the clinical setting with large variation in execution among respondents and many logistical concerns regarding implementation. Future research may be beneficial to evaluate how practices change as HMA and individualized fortification gain popularity and become more commonly used in the clinical setting.

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Section: Barrier 1: Who Should Receive Hma and Individualized Fortification And How Often?mentioning

confidence: 99%

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

et al. 2021

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“…Human milk is fortified using the standard method, which consists of the addition of a fixed dose of a HM multi-nutrient fortifier, according to the manufacturer’s instructions [ 14 ]. This method does not take into account the great variability of the nutritional composition of HM [ 13 , 14 , 15 , 16 ] and so does not avoid the risks associated with energy–protein malnutrition, poor neurodevelopmental outcome, and metabolic bone disease [ 17 , 18 , 19 ]. In an attempt to overcome this problem, alternative individualized HM fortification methods have been proposed, particularly target fortification [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

Cardoso

Virella

Macedo

et al. 2021

IJERPH

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Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

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Comparison of different protein concentrations of human milk fortifier for promoting growth and neurological development in preterm infants

Gao

Miller

Collins

et al. 2020

Cochrane Database of Systematic Reviews

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Targeted or adjustable versus standard diet fortification for growth and development in very low birth weight infants receiving human milk

Cited by 4 publications

References 28 publications

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States

Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

Comparison of different protein concentrations of human milk fortifier for promoting growth and neurological development in preterm infants

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