446 - An Exclusive Human Milk Diet May Improve Essential Fatty Acid Intake for Extremely Low Birthweight Infants

Poster Number: 446
Publication Number: 446.2190

Background: Long chain poly unsaturated fatty acid intake in preterm infants is necessary for improved neurodevelopmental outcomes, has been associated with decreased morbidities, and is required for adequate linear growth. Preterm infants are born prior to peak fetal accretion periods for docosahexaenoic acid (DHA) and arachidonic acid (AA), levels decrease significantly in the first weeks of life, and deficits are more pronounced in lower birth weights. Wide variations of fatty acids are present in human milk, and supplementation is required.

Objective: We hypothesize that an exclusive human milk diet, utilizing mom’s own milk or donor human milk with human-derived fortifiers can support essential fatty acid intake and mitigate deficits early in life.

Design/Methods: Feeding data and fatty acid levels were collected on infants with birthweight of 1000 grams or less born between February and August of 2021. Total volumes of human milk and human derived fortifiers and cream were recorded for each infant daily. Infants received mom’s own milk or donor human milk. Milk was fortified with human derived fortifier to 24 cal/oz at 40mL/kg/day, to 26cal/oz at 60mL/kg/day, and 4mL human derived cream was added per 100mL. Fatty acid intakes were then calculated using known levels in the donor milk and fortifiers, and reported as mg/infant/day. Fatty acid panels were analyzed at DOL 0-3, DOL 7, first day of full feeding volume, and DOL 30 and are reported as µmol/L.

Results: 27 Infants were included, with average birthweight of 773 grams and average gestational age 26 weeks and 3 days; 26.9% were small for gestational age. Full feeds were reached at an average of 14 days. Levels of enteral fatty acid intake and serum levels are reported in Table 1. DHA did not decline until after the first week of life and by 30 days had increased back to birth levels.

Conclusion(s): Many studies have described decreased neonatal morbidities with use of an exclusive human milk diet, and essential fatty acid intakes have also been tied to improved outcomes of extremely premature infants. Levels of DHA and ARA in our population experienced less of a decline than has been previously reported. Early fortification with an exclusive human milk diet may provide more optimal essential fatty acid intake and prevent significant deficits in these highest risk patients.
We plan to compare similar data for larger birthweight infants during the same time period who received bovine fortification.