Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study

Tarah T Colaizy,Frank H Morriss,Susan Carlson,Audrey F Saftlas

doi:10.1186/1471-2431-12-124

Tarah T Colaizy, Frank H Morriss + Show 2 more

Open Access

https://doi.org/10.1186/1471-2431-12-124

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Abstract

BackgroundTo determine the effect of human milk, maternal and donor, on in-hospital growth of very low birthweight (VLBW) infants. We performed a retrospective cohort study comparing in-hospital growth in VLBW infants by proportion of human milk diet, including subgroup analysis by maternal or donor milk type. Primary outcome was change in weight z-score from birth to hospital discharge.MethodsRetrospective cohort study.Results171 infants with median gestational age 27 weeks (IQR 25.4, 28.9) and median birthweight 899 g (IQR 724, 1064) were included. 97% of infants received human milk, 51% received > 75% of all enteral intake as human milk. 16% of infants were small-for-gestational age (SGA, < 10th percentile) at birth, and 34% of infants were SGA at discharge. Infants fed >75% human milk had a greater negative change in weight z-score from birth to discharge compared to infants receiving < 75% (−0.6 vs, -0.4, p = 0.03). Protein and caloric supplementation beyond standard human milk fortifier was related to human milk intake (p = 0.04). Among infants receiving > 75% human milk, there was no significant difference in change in weight z-score by milk type (donor −0.84, maternal −0.56, mixed −0.45, p = 0.54). Infants receiving >75% donor milk had higher rates of SGA status at discharge than those fed maternal or mixed milk (56% vs. 35% (maternal), 21% (mixed), p = 0.08).ConclusionsVLBW infants can grow appropriately when fed predominantly fortified human milk. However, VLBW infants fed >75% human milk are at greater risk of poor growth than those fed less human milk. This risk may be highest in those fed predominantly donor human milk.

Highlights

To determine the effect of human milk, maternal and donor, on in-hospital growth of very low birthweight (VLBW) infants
extremely low birthweight (ELBW) infants fed maternal milk have lower rates of necrotizing enterocolitis (NEC) [1,2,3], the combined outcome of NEC or death [4], late onset sepsis [2,5,6], and have superior neurodevelopmental outcomes compared with those fed preterm formulas [7,8]
Those outcomes represented an apparent improvement in rates of growth failure among VLBW infants in the Neonatal Research Network (NRN), as 97% of 4438 infants admitted to NRN centers between 1995 and 1996 were SGA at postmenstrual age at 36 weeks [20]

Summary

Introduction

To determine the effect of human milk, maternal and donor, on in-hospital growth of very low birthweight (VLBW) infants. We performed a retrospective cohort study comparing in-hospital growth in VLBW infants by proportion of human milk diet, including subgroup analysis by maternal or donor milk type. Maternal milk diets have been associated with advantages for extremely low birthweight (ELBW) infants. Maternal milk diets have been associated with inferior in-hospital growth when compared with preterm formula. A later study comparing fortified donor milk and preterm formula as supplements to fortified maternal milk found slower growth associated with donor milk [1]. Further studies of fortified maternal milk diets are needed to determine the growth effects in the era of routine fortification. ‘donor human milk’ refers to milk expressed by volunteer milk donors, processed by the Mother’s Milk Bank of Iowa

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