681 - Human Milk Fortification: Impact of a New Fortifier on Growth Velocity and Tolerance

Poster Number: 681
Publication Number: 681.232

Fernando R. Moya, University of North Carolina at Chapel Hill School of Medicine, Wilmington, NC, United States; Jennifer Fowler, James and Connie Maynard Children's Hospital at Vidant Medical Center, Washington, NC, United States; Adrian Florens, KIDZ MEDICAL SERVICES . Palm Beach Children’s Hospital , West Palm Beach FL, Delray Beach, FL, United States; Kirsten Frank, Betty H Cameron Womens Childrens Hospital, Wilmington, NC, United States; Olivia Davis, Kidz Medical Services, West Palm Beach, FL, United States; Tiffony R. Blanks, University of North Carolina at Chapel Hill School of Medicine, Wilmington, NC, United States; Austin Gratton, SEAHEC, Leland, NC, United States; Jennifer Dombrowski, Kidz Medical Services, Loxahatchee, FL, United States

Background: Human milk fortifiers (HMF) of bovine origin or derived from human milk are commonly used for feeding preterm infants. A liquid acidified HMF (ALHMF, Mead Johnson Nutrition) was shown to promote better growth than its powdered formulation (Moya F, Pediatrics 2012,130: e928). This ALHMF was recently replaced by a liquid preparation with a relatively similar nutrient composition, but without using acidification in its formulation (NALHMF, Mead Johnson Nutrition). Therefore, it would be important to assess growth, tolerance and other variables with the use of the new NALHMF in a large cohort of preterm infants.

Objective: To compare growth velocity, tolerance, and morbidity like Sepsis/NEC among preterm infants receiving ALHMF versus another cohort that received NALHMF.

Design/Methods: We conducted a multicenter, retrospective comparison of growth and other variables among infants receiving ALHMF vs NALHMF in three institutions. Demographic information, growth parameters, daily enteral and parenteral intake, serum chemistries, acid base status, and morbidity/mortality data were collected in deidentified forms. Comparison between both groups were done using Wilcoxon Mann Whitney test for continuous variables due to non-normality. Chi-squared test was used for categorical variables. Growth velocity was calculated using the Exponential method. A P < 0.05 was considered significant.

Results: A total of 539 infants were enrolled. The main demographics were not different between groups (Table 1). Donor milk was used in 63% and 60% of infants receiving ALHMF versus NALHMF, respectively. Over 90% and 60% of infants were receiving either fortifier at 2 and 4 weeks, respectively (Table 2). Growth velocity was higher in the group receiving the NALHMF after 2 and 4 weeks of fortification (11.7 vs. 13.4, and 15.8 vs. 16.4 g/kg/d, respectively). Tolerance (stopping feeds for > 8 hr) in any given week of fortification was uncommon (0-8%) and not different between groups. There were no differences in corrected gestational age or anthropometric measures at discharge. Proven sepsis or NEC (stage 2 or higher) were uncommon and did not differ among groups (9.8 versus 8.7%, and 5.7 versus 4.7%, respectively). Also, length of stay was comparable between groups.

Conclusion(s): Preterm infants fed human milk fortified with NALMH had a greater growth velocity at 2 and 4 weeks after starting fortification. Nonetheless, there were no differences in length of stay or anthropometric measures at discharge. Tolerance was comparable between fortifiers. The new NALMH is a good alternative to the ALHMF for use in preterm infants.