474 - Targeted Donor Breast Milk Fortification in Preterm Infants

Poster Number: 474
Publication Number: 474.1285

Background: Mother’s own milk (MOM) is the preferred source of nutrition for most infants. When unavailable, donor human milk (DHM) is preferred to formula for very low birth weight (VLBW) infants. The macronutrient content of DHM is less than MOM and may be insufficient to meet the needs of preterm infants with standard fortification. The role of targeted fortification of DHM in preventing growth failure in preterm population is currently unknown.

Objective: To evaluate the effect of targeted DHM fortification on growth outcomes in preterm infants.

Design/Methods: This is a prospective randomized controlled trial (NCT04294368) of preterm ( < 30 weeks GA) and VLBW ( < 1500gm) infants comparing standard fortification (4 packets of bovine liquid human milk fortifier, HMF) and targeted fortification of DHM. DHM was analyzed using the Miris Analyzer. In the intervention arm, after addition of HMF, liquid protein and/or micro-lipid were used to achieve a protein content of 2.5g/100ml and overall caloric value of 80kcal/100ml. Block randomization was used across 3 weight groups and was done on reaching 24 calories within 3 weeks of birth. Other exclusion criteria were < 3rd percentile, major congenital anomalies, IVH > grade 3, and early intestinal complication. MOM was always used when available. Groups were analyzed based on the receipt of > or < 30% DHM. The primary outcome of interest was change in weight z-scores from date of study randomization to 34 weeks corrected gestational age (CGA).

Results: For this interim analysis, 28 subjects completed the study from 1/1/2020-10/1/2023. Study population diversity reflected that of the NICU (table 1). Univariate analysis of the two groups found no significant difference in demographic characteristics. 12 infants (43%) received exclusive MOM and 14 (50 %) received more than 30% DHM. The range of additional fortification in the intervention arm was 1-2 ml microlipid (4.5kcal/ml) and 1-4 ml liquid protein (0.17g protein/ml) per 100 ml DHM. Infants receiving mostly DHM had a greater decrease in weight z-scores compared to infants receiving mostly MOM, but was less marked in infants who received targeted DHM fortification (table 2). Moreover, 88% of infants in the control group receiving DHM were given additional fortification due to growth concerns by the clinical team.

Conclusion(s): Targeted DHM fortification shows a trend toward improved growth outcomes among preterm infants as compared to standard fortification, creating an opportunity to prevent growth failure among preterm infants receiving DHM in the NICU.