Human Milk Fortification in Very Preterm Infants in China: A Multicenter Survey.

Rong Lin,Fan Wu,Xiaomei Tong,Rong Zhang,Yinping Qiu,Yanmei Chang,Dongmei Chen,Rui Cheng,Jian Mao,Li Ma,Ling Liu,The National Multicenter Eugr Collaborative Group ,Wei Shen,Zhi Zheng,Xiuzhen Ye,Hui Wu,Xinzhu Lin

doi:10.3389/fped.2022.795222

Abstract

AimTo investigate the use of human milk fortifier (HMF) for very preterm infants (VPIs) and complications and nutritional status of VPIs due to various breast milk enhancement strategies among the Chinese population.MethodsVPIs with birth weight < 1,800 g and wholly or predominantly breastfed were assigned to the following fortification groups: no HMF, early HMF (adding HMF at an enteral volume of ≤ 80 ml·kg−1·day−1), middle HMF (adding HMF at an enteral volume of 80–100 ml·kg−1·day−1), and late HMF (adding HMF at an enteral volume of ≥100 ml·kg−1·day−1). The growth status and complications for various groups were evaluated.ResultsWe enrolled 985 VPIs, of which 847 VPIs (86.0%) received HMF, whereas 138 VPIs (14.0%) did not. The number of VPIs in the early, middle, and late fortification groups were 89 (9.0%), 252 (25.6%), and 506 (51.4%), respectively. The complete fortification of the early, middle, and late fortification groups was achieved in 13.2 ± 11.0, 13.8 ± 11.7, and 12.3 ± 13.0 days, respectively, without significant differences (p > 0.05). The groups did not exhibit significant differences in the incidence of feeding intolerance, necrotizing enterocolitis (Bell stage ≥ 2), late-onset sepsis, and metabolic bone diseases (p > 0.05). The middle fortification groups exhibited the fastest growth velocity and the least dramatic decrease in the Z-score of weight and length, and the lowest incidence of EUGR (35.7%), whereas the “no HMF” groups exhibited the slowest growth velocity and the largest decline in the Z-score, and the highest incidence of EUGR (61.6%).ConclusionsThe usage rate of HMF was relatively low among Chinese VPIs, fortification often occurred in the late feeding stage, and the time to reach complete fortification was long. Adding HMF and different breast milk enhancement strategies did not increase the incidence of feeding intolerance and necrotizing enterocolitis. The enteral volume of 80–100 ml·kg−1·day−1 with HMF addition led to increased growth in the weight and length and lower EUGR incidence, indicating that the addition of HMF at the specific feeding volume might be the best practice for promoting growth.

Highlights

MATERIALS AND METHODSHuman milk is the best source of nutrition for all infants, especially for preterm infants, as it better compensates for the immature immune, vascular, and neurological systems
There were no significant differences in sex, donor human milk use, Apgar score, and incidence of intrauterine growth restriction (IUGR) (p > 0.05) among the four groups
Significant differences were reported in the gestational age (GA) at birth and discharge, birth weight (BW), birth length, birth head circumference (HC), and hospital stay (p = 0.000) (Table 1)

Summary

Introduction

Human milk is the best source of nutrition for all infants, especially for preterm infants, as it better compensates for the immature immune, vascular, and neurological systems. From a nutritional point of view, human milk alone cannot provide sufficient energy and nutrition for preterm infants. Human milk intake as high as 250–350 ml/kg/day may theoretically cover protein needs for preterm infants, but a high intake does not correct the suboptimal protein-to-energy ratio with the resulting risk of excessive fat deposition [2]. Breastfeeding without human milk fortifier (HMF) results in the development of metabolic bone diseases and other complications. To prevent nutritional insufficiencies related to human milk while taking advantage of its biological properties, HMF are used for preterm infants [3]

Objectives

Results

Discussion

Conclusion