Medical Student University of South Dakota, Sanford School of Medicine Sioux Falls, South Dakota, United States
Background: Human breast milk (HM) is the best form of nutrition for preterm (PT) infants. However, HM is deficient in essential nutrients, namely protein, calcium, and phosphorus. In order to achieve adequate growth, HM feeds must be fortified with human milk fortifiers (HMF). Currently available fortification products are classified as bovine-based HMF (BVHMF) and HM-based HMF (HMHMF) that provide the essential macro and micronutrients. However, there are concerns for poor growth when infants are primary fortified with HMBHMF when compared to BMHMF. Objective: The objective of this study was to examine the impact of HMHMF compared to BVHMF on the body composition (weight, length, head circumference (HC)) of PT infants at 28 days of age and discharge. Design/Methods: This is a retrospective cohort study of 90 PT infants born < 30 weeks gestational age (GA) between 2018-2022 at a level III NICU who were categorized as receiving either BVHMF (n=56) or HMHMF (n=34). Characteristics including sex, race, GA, and birthweight (BW), along with nutritional interventions such as average protein on day of life (DOL) 7-14, DOL of full feedings, and DOL of fortification were examined for differences using chi-square tests and t-tests. Means ± SD are reported. Regression analyses examined growth outcomes while controlling for characteristics that differed between groups (BW and GA). Statistical significance was determined using a p< 0.05. Results: The study sample (n=90) was majority male (56%) and non-Hispanic white (82%). Characteristics that differed included GA in weeks (27.9 ± 1.5 vs 26.4 ± 1.8, p<.0001) and BW in grams (1115 ± 266 vs 924 ± 272, p=.0016). Z-scores at birth for HC, length, and weight did not differ statistically between groups (all p>0.05). Growth outcomes included changes in Z-scores for HC, length, and weight for three different time periods (0-28 days, 28 days to discharge, and day 0 to discharge). Among all growth outcomes, only change in Z-score for HC between day 0 to discharge differed. HMHMF infants had a larger negative change in Z-score compared to BVHMF infant (i.e., smaller HC; -1.19 ± .20 vs -.61 ± .15, p=.034). In post-hoc analyses, significant differences in change in Z-score HC between day 0 and discharge were no longer seen. No differences in other outcomes.
Conclusion(s): HMHMF fortification of HM feedings was not inferior to BVHMF feedings in providing adequate growth trajectories in PT infants at discharge. Adequate growth milestones can be achieved in those PT infants most at risk with an exclusive human milk diet.
