Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol.

Manuela Cardoso,Daniel Virella,Israel Macedo,Luís Pereira-Da-Silva,Diana Silva

doi:10.3390/ijerph18020823

Abstract

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

Highlights

This method does not take into account the great variability of the nutritional composition of human milk (HM) [13,14,15,16] and so does not avoid the risks associated with energy–protein malnutrition, poor neurodevelopmental outcome, and metabolic bone disease [17,18,19]
In a cohort study of very preterm infants fed standard fortified HM, we previously evaluated the association between energy and macronutrient intakes and both weight gain velocity and body composition [34,35]
We hypothesize that the HM fortification method based on measured HM composition will result in higher energy and macronutrient intakes and faster weight gain velocity than previously observed [35]

Summary

Introduction

Human milk (HM) is the first choice for feeding preterm infants [1], as it is the better option that compensates for the immature immune [2,3], vascular [4], and neurological [5]. In very and extremely preterm infants, HM has beneficial effects on the neurodevelopmental outcome [6] and preventive effects on morbidities, including retinopathy of prematurity [7], bronchopulmonary dysplasia [8], necrotizing enterocolitis [7,9], and late sepsis [9].

Methods

Discussion

Conclusion