Concentrated Preterm Formula as a Liquid Human Milk Fortifier at Initiation Stage in Extremely Low Birth Weight Preterm Infants: Short Term and 2-year Follow-up Outcomes.

Yung-Chieh Lin,Yen-Ju Chen,Chi-Chang Shieh,Chao-Ching Huang

doi:10.3390/nu12082229

Yung-Chieh Lin, Yen-Ju Chen + Show 2 more

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https://doi.org/10.3390/nu12082229

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Abstract

Human milk (HM) must be accurately fortified for extremely low birth weight (ELBW) preterm infants with human milk fortifiers (HMFs). Powdered HMF has some limitations in terms of sterilization and accuracy. A concentrated preterm formula (CPF) may serve as a safe liquid HMF to facilitate growth. Hence, we launched a quality improvement project for fortification accuracy of minute volume HM. A CPF, Similac Special Care 30 (SSC30), was newly introduced as an HMF when daily feeding reached 100 cm3/kg. CPF + HM (1:2 volume ratio), CPF + HM (1:1 volume ratio), and powdered HMF + HM (1 packet in 25 cm3) represented three fortification stages. Fortification shifted to powdered HMF while tolerable feeding reached 25 cm3/meal. The outcome was compared before (Period-I, January 2015 to June 2016, n = 37) and after the new implement (Period-II, July 2016 to December 2017, n = 36). Compared with the Period-I group, the Period-II group had significantly higher daily enteral milk intake in the first 4 weeks of life, and higher percentages of fortification in the HM-fed infants in the first 8 weeks after birth. The Period-II group also significantly increased in body weight growth in terms of z-score at term equivalent age (p = 0.04) and had better language and motor performance at 24 months old (p = 0.048 and p = 0.032, respectively). Using the liquid CPF as a strategical alternative fortification of HM might be beneficial for extremely preterm infants in terms of growth as well as neurodevelopment.

Highlights

Human milk (HM) is the first choice of feeding for preterm infants [1,2,3]
HM has numerous benefits for preterm infants to reduce the risks of diseases, such as necrotizing enterocolitis (NEC) [4,5,6], nosocomial infection, sepsis [7], and bronchopulmonary dysplasia [8]
Human milk fortifier (HMF) (24 kcal/oz) is indicated for all breast milk-fed infants weighing less than 2000 g and should be initiated when the infant is tolerating breast milk feeds of 25 cm3 /day

Summary

Introduction

Human milk (HM) is the first choice of feeding for preterm infants [1,2,3]. The consumption of HM is associated with the improvements in neurodevelopmental outcomes in preterm infants [7,9,10]. The nutritional content of unfortified HM, can not completely support the growth of preterm infants [11,12]. The literature recommends fortified human milk in infants born before 32 weeks gestation and for certain infants born at 32–36 weeks of gestation [13]. Human milk fortifier (HMF) (24 kcal/oz) is indicated for all breast milk-fed infants weighing less than 2000 g and should be initiated when the infant is tolerating breast milk feeds of 25 cm3 /day. Infants receiving 25 cm of Nutrients 2020, 12, 2229; doi:10.3390/nu12082229 www.mdpi.com/journal/nutrients

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