Neonatal-Perinatal Fellow Loma Linda University Children's Hospital Loma Linda, California, United States
Background: Optimal nutrition for preterm infants is a challenge. Poor postnatal growth is associated with neurocognitive impairment. On the contrary, excessive fat mass gain is associated with negative long-term metabolic consequences such as insulin resistance and obesity. Targeted nutrition is an approach that provides well balanced nutrition. Nutritional analysis of mother’s milk allows individualized fortification to meet the specific growth needs of each baby. This approach has been studied in extremely preterm infants born at less than 30 weeks gestation. However, approximately 90% of all preterm births occur between 30-36 weeks gestation. These moderate to late preterm infants have a 2-to-10 fold increase in morbidities compared to term infants. Yet targeted nutrition for this population has not been studied. We wish to address this research gap by applying targeted nutrition to preterm infants born between 30-36 weeks gestation and analyzing their postnatal growth. Objective: Determine if targeted nutrition for moderate to late preterm infants born between 30-36 weeks gestation optimizes their postnatal growth. Design/Methods: Infants born between 30-36 weeks gestation who are receiving any amount of mother's milk will be enrolled. The mother/infant dyad will be randomized into standard fortification arm (control group) or targeted fortification arm (intervention group). Both groups will have mothers' pooled breast milk analyzed using Miris Human Milk Analyzer once a week until the time of discharge. For the control group, mother’s milk will be fortified using bovine-based liquid human milk fortifier per Neonatal Intensive Care Unit protocol. For the intervention group, mother’s milk will be fortified individually to meet the macronutrient guidelines outlined by The European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Anthropometric measurements (weight, length, and head circumference) will be taken once a week for all infants. Birth and discharge Z-scores of the anthropometric measurements will be used to compare the growth trajectories.
