The effect of milk type and fortification on the growth of low‐birthweight infants: An umbrella review of systematic reviews and meta‐analyses

Abstract

Approximately 15% of infants worldwide are born with low birthweight (<2500 g).These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in lowbirthweight infants, with particular focus on low-and lower middle-income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty-six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high-income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother's milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500-2500 g in low-and lower middle-income countries.

Mixed-methods, descriptive and observational cohort study examining feeding and growth patterns among low birthweight infants in India, Malawi and Tanzania: the LIFE study protocol

“…The LIFE study will fill critical data gaps in the care and nutrition of LBW infants in LMICs; although limited, most of the existing research in this area is concentrated in high-income countries 18. Overall, evidence is lacking on feeding, care and health of LBW infants born with birth weights of 1.5 to <2.5 kg; however, these moderately LBW infants represent the majority (>90%) of global LBW births compared with very LBW infants (<1.5 kg) 2 17 18 44–46.…”

“…The LIFE study will fill critical data gaps in the care and nutrition of LBW infants in LMICs; although limited, most of the existing research in this area is concentrated in high-income countries 18. Overall, evidence is lacking on feeding, care and health of LBW infants born with birth weights of 1.5 to <2.5 kg; however, these moderately LBW infants represent the majority (>90%) of global LBW births compared with very LBW infants (<1.5 kg) 2 17 18 44–46. We will aim to establish the foundational knowledge required to design, test and implement the most effective and feasible infant feeding strategies to prevent and address growth faltering among LBW infants in low-resource settings.…”

“…[15][16][17] Generally, studies capturing evidence on optimal milk type and content for moderately LBW infants (1.5 kg to <2.5 kg) in low-resource settings are lacking, hindering the proper management of nutritionally at-risk newborns. 18 The World Health Organization (WHO) feeding guidelines for LBW infants were published in 2011 19 ; however, most of the recommendations are based on low quality evidence; even so, the majority of available evidence was from high-income countries, and most data were limited to very LBW infants (<1.5 kg) even though the majority of LBW infants are born between 1.5 kg to <2.5 kg. 12 20 Opportunity Despite these gaps, a number of opportunities in recent years have propelled interest and investment in the care of LBW infants.…”

“…Limited evidence exists, particularly in low-resource settings, on feeding patterns and initiation, the feeding ecosystem, policies for the care of LBW infants and supply and demand inputs related to various feeding modes 15–17. Generally, studies capturing evidence on optimal milk type and content for moderately LBW infants (1.5 kg to <2.5 kg) in low-resource settings are lacking, hindering the proper management of nutritionally at-risk newborns 18. The World Health Organization (WHO) feeding guidelines for LBW infants were published in 201119; however, most of the recommendations are based on low quality evidence; even so, the majority of available evidence was from high-income countries, and most data were limited to very LBW infants (<1.5 kg) even though the majority of LBW infants are born between 1.5 kg to <2.5 kg 12 20…”

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

“…For infants born smallfor-gestational-age (SGA), one study suggested a greater positive effect of fortification on growth rates compared to those born appropriate-for-gestational age (AGA) [60]. A recent large umbrella review of breast milk fortification in VLBW infants found evidence that the multicomponent fortification-with the addition of protein and energy (as fat or carbohydrate)-led to significant increases in weight, length, and head circumference [61].…”