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Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier.
J Neonatal Perinatal Med. 2020; 13(2):215-221.JN

Abstract

BACKGROUND

An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet.

OBJECTIVE

The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier.

STUDY DESIGN

A multi-center retrospective cohort study of the outcomes of infants of 500- 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume.

RESULTS

Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification.

CONCLUSION

The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group.

Authors+Show Affiliations

Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR, USA.Prolacta Bioscience, Duarte, CA, USA.Providence Alaska Medical Center, Anchorage, AK, USA.Providence St. Vincent Medical Center, Portland, OR, USA.Billings Clinic, Billings, MT, USA.Salem Health Hospitals and Clinics, Salem, OR, USA.Prolacta Bioscience, Duarte, CA, USA.Providence Alaska Medical Center, Anchorage, AK, USA.Providence St. Vincent Medical Center, Portland, OR, USA.Billings Clinic, Billings, MT, USA.Billings Clinic, Billings, MT, USA.Salem Health Hospitals and Clinics, Salem, OR, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31707377

Citation

Huston, Robert, et al. "Early Fortification of Enteral Feedings for Infants <1250 Grams Birth Weight Receiving a Human Milk Diet Including Human Milk Based Fortifier." Journal of Neonatal-perinatal Medicine, vol. 13, no. 2, 2020, pp. 215-221.
Huston R, Lee M, Rider E, et al. Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier. J Neonatal Perinatal Med. 2020;13(2):215-221.
Huston, R., Lee, M., Rider, E., Stawarz, M., Hedstrom, D., Pence, M., Chan, V., Chambers, J., Rogers, S., Sager, N., Riemann, L., & Cohen, H. (2020). Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier. Journal of Neonatal-perinatal Medicine, 13(2), 215-221. https://doi.org/10.3233/NPM-190300
Huston R, et al. Early Fortification of Enteral Feedings for Infants <1250 Grams Birth Weight Receiving a Human Milk Diet Including Human Milk Based Fortifier. J Neonatal Perinatal Med. 2020;13(2):215-221. PubMed PMID: 31707377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier. AU - Huston,Robert, AU - Lee,Martin, AU - Rider,Evelyn, AU - Stawarz,Melissa, AU - Hedstrom,Dawn, AU - Pence,Melissa, AU - Chan,Vera, AU - Chambers,Jessica, AU - Rogers,Stefanie, AU - Sager,Nadine, AU - Riemann,Laurie, AU - Cohen,Howard, PY - 2019/11/11/pubmed PY - 2019/11/11/medline PY - 2019/11/11/entrez KW - Human milk KW - clinical outcomes KW - fortification KW - growth SP - 215 EP - 221 JF - Journal of neonatal-perinatal medicine JO - J Neonatal Perinatal Med VL - 13 IS - 2 N2 - BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500- 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification. CONCLUSION: The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group. SN - 1878-4429 UR - https://www.unboundmedicine.com/medline/citation/31707377/Early_fortification_of_enteral_feedings_for_infants_<1250_grams_birth_weight_receiving_a_human_milk_diet_including_human_milk_based_fortifier L2 - https://content.iospress.com/openurl?genre=article&amp;id=doi:10.3233/NPM-190300 DB - PRIME DP - Unbound Medicine ER -
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