Abstract
Fortification of human milk (HM) for preterm and very low-birth weight (VLBW) infants is a standard practice in most neonatal intensive care units. The optimal fortification strategy and the most suitable protein source for achieving better tolerance and growth rates for fortified infants are still being investigated. In a previous clinical trial, preterm and VLBW infants receiving supplementation of HM with experimental donkey milk-based fortifiers (D-HMF) showed decreased signs of feeding intolerance, including feeding interruptions, bilious gastric residuals and vomiting, with respect to infants receiving bovine milk-based fortifiers (B-HMF). In the present ancillary study, the urinary metabolome of infants fed B-HMF (n = 27) and D-HMF (n = 27) for 21 days was analyzed by 1H NMR spectroscopy at the beginning (T0) and at the end (T1) of the observation period. Results showed that most temporal changes in the metabolic responses were common in the two groups, providing indications of postnatal adaptation. The significantly higher excretion of galactose in D-HMF and of carnitine, choline, lysine and leucine in B-HMF at T1 were likely due to different formulations. In conclusion, isocaloric and isoproteic HM fortification may result in different metabolic patterns, as a consequence of the different quality of the nutrients provided by the fortifiers.
Highlights
The achievement of optimal growth is one of the main targets for the successful management of preterm infant care [1]
The relative risk (RR) ratio for feeding intolerance, defined as interruption of enteral feeding for at least eight consecutive hours during the observation period, was found to be 0.40 in the Donkey—Human Milk Fortifier (D-HMF) group, equal to that reported in the main clinical trial
Significant differences for the two groups were found for the time needed to reach a full enteral feeding and for the occurrence of breastmilk at discharge, with the D-HMF group reaching the goal two days before Bovine—Human Milk Fortifier (B-HMF), and having a higher prevalence (1.58 RR) of infants receiving breastmilk
Summary
The achievement of optimal growth is one of the main targets for the successful management of preterm infant care [1]. Inadequate nutrition and/or poor postnatal growth have been reported as negatively associated with neurocognitive outcomes in preterm infants [2]. Nutrients 2020, 12, 2247 nutritional management of preterm newborns may increase the risk of developing cardiovascular and metabolic diseases in adult life, such as dyslipidemia, insulin resistance and type 2 diabetes [3]. Provision of optimal nutrition in the neonatal period, for very-low birth weight The effects of different levels of fortification on short-term growth and their impact on metabolic responses of preterm infants have been topics of discussion
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