325 - Growth of preterm infants on hydrolyzed protein concentrated liquid bovine-fortifier (HPCL HMF) is superior to concentrated liquid fortifier (CL HMF)

Fortification with protein and minerals is recommended for all human milk (HM) to ensure optimal delivery of nutrients to preterm infants. Despite addition of HM fortifier (HMF), infants with poor linear growth often require liquid protein (LP) modular. Various HMF products are used leading to wide practice variation across neonatal intensive care units (NICUs).

Objective:

(1) Evaluate growth and blood urea nitrogen (BUN) in preterm infants receiving HM fortified with bovine fortifiers: concentrated liquid fortifier (CL HMF) vs hydrolyzed protein concentrated liquid fortifier (HPCL HMF). (2) Evaluate whether use of HPCL HMF vs CL HMF is associated with decreased LP modular provision.

Design/Methods: A retrospective sample of preterm infants with birth weight < 1500 g or gestational age (GA) < 33 weeks admitted to a level 3 NICU and born during Jan 2017- 2018 (CL HMF era) or Mar 2018-2019 (HPCL HMF era) was included. Infants who received < 14 days of fortified feedings, were NPO or received unfortified feeds for >24h during study period were excluded. Data were extracted from electronic medical record and nutrition datasheets. Study day 1 was defined as 1st day of full fortification with a primary study period of study days 1-14. Study weeks 3 and 4 were also examined. Anthropometrics, mean calorie and protein intake, BUN, and change in head circumference (HC), weight and length Z-scores were assessed. Protein modular use and type of milk were quantified. Data analysis included t-tests, Mann Whitney U tests, chi-square tests and linear regression.

Results: 155 preterm infants were included with 85 CL HMF infants and 70 HPCL HMF infants. A greater proportion of HPCL HMF infants were small for gestational age at birth compared to CL HMF infants (Table 1). No differences in type of milk, mean enteral volume, calorie or protein from fortified milk intake were found between CL HMF and HPCL HMF eras. HPCL HMF infants had greater HC Z-scores at 29 days and BUN levels at study days 14, 22 and 29 compared to CL HMF infants (Table 2). HPCL HMF infants were less likely to receive any LP (17% vs 76%, p< .001) and received fewer days of LP than CL HMF infants.

Conclusion(s): Infants on HPCL HMF had significantly higher HC Z-scores at study days 14, 22 and 29 despite being smaller at birth than CL HMF infants. Although LP modular use decreased in the HPCL HMF era, these infants had greater BUN levels suggesting improved protein stores. A transition from CL HMF to HPCL HMF may have important implications for infant growth and NICUs due to less LP modular use and associated personnel time for LP administration.