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Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk.
Breastfeed Med. 2020 May; 15(5):297-303.BM

Abstract

Objective:

An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention.

Study Design:

We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes.

Results:

CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04).

Conclusions:

In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death.

Authors+Show Affiliations

Institute of Child Health, University College, London, United Kingdom.Department of Medicine and University of California, San Francisco, California, USA. Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA.Department of Pediatrics, Dell Medical School, The University of Texas, Austin, Texas, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32239968

Citation

Lucas, Alan, et al. "Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk." Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine, vol. 15, no. 5, 2020, pp. 297-303.
Lucas A, Boscardin J, Abrams SA. Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk. Breastfeed Med. 2020;15(5):297-303.
Lucas, A., Boscardin, J., & Abrams, S. A. (2020). Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk. Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine, 15(5), 297-303. https://doi.org/10.1089/bfm.2019.0133
Lucas A, Boscardin J, Abrams SA. Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk. Breastfeed Med. 2020;15(5):297-303. PubMed PMID: 32239968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk. AU - Lucas,Alan, AU - Boscardin,John, AU - Abrams,Steven A, Y1 - 2020/04/02/ PY - 2020/4/3/pubmed PY - 2020/4/3/medline PY - 2020/4/3/entrez KW - cow's milk-derived fortifier KW - fortifiers KW - human milk KW - human milk-derived fortifier KW - human nutrition KW - infant feeding KW - necrotising enterocolitis SP - 297 EP - 303 JF - Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine JO - Breastfeed Med VL - 15 IS - 5 N2 - Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death. SN - 1556-8342 UR - https://www.unboundmedicine.com/medline/citation/32239968/Preterm_Infants_Fed_Cow's_Milk-Derived_Fortifier_Had_Adverse_Outcomes_Despite_a_Base_Diet_of_Only_Mother's_Own_Milk L2 - https://www.liebertpub.com/doi/10.1089/bfm.2019.0133?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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