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Neonatal Fetal Nutrition & Metabolism

Neonatal Fetal Nutrition & Metabolism 2: Neonatal Nutrition, Growth, and Outcomes

324 - Effect of targeted vs. standard fortification of breast milk on growth and development of preterm infants (≤ 32 weeks): re-sults from an interrupted randomized controlled trial

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 324
Publication Number: 324.129

Joanna Seliga-Siwecka, Medical University of Warsaw, Warsaw, Mazowieckie, Poland; Anna Chmielewska, Umeå University, Sweden, Umeå, Vasterbottens Lan, Sweden; Justyna Marta. Fiałkowska, Dutchess Ann Mazowiecka University Hospital Warsaw, Warsaw, Mazowieckie, Poland

Presenting Author(s)

JS

Joanna Seliga-Siwecka, MD PhD (she/her/hers)

Physician
Medical University of Warsaw
Warsaw, Mazowieckie, Poland

Background: Human milk is recommended for very low birth weight infants. Their nutritional needs are high, and the fortification of human milk is a standard procedure to optimize growth. Targeted fortification accounts for the variability in human milk composition. It has been a promising alternative to standard fixed-dose fortification, potentially improving short-term growth.

Objective:

The primary objective was to determine whether tailored compared to the standard fortification of enteral nutrition improved weight gain velocity in preterm infants born at ≤ 32 weeks of gestation.   

The key secondary objective was to determine the following anthropometric parameters in preterm infants born at ≤ 32 weeks of gestation at discharge and 4 months:  feeding tolerance, velocity of weight gain, length and head growth.

Design/Methods: . In this trial, preterm infants (≤ 32 weeks of gestation) were randomized to receive human milk after standard fortification (HMF, Nutricia) or tailored fortification with modular components of proteins (Bebilon Bialko, Nutricia), carbohydrates (Polycal, Nutricia), and lipids (Calogen, Nutricia). The intervention started when preterms reached 80 ml/kg/day enteral feeds.

Results: Of the target number of 220 newborns, 39 were randomized. The trial was interrupted due to serious intolerance in five cases. There was no significant difference in velocity of weight gain during the supplementation period (primary outcome) in the tailored vs. standard fortification group: 27.01 ± 10.19 g/d vs. 25.84 ± 13.45 g/d, p=0.0776. Length and head circumference were not significantly different between the groups.

Conclusion(s):

Targeted milk modification is a strategy that may allow optimization of growth in premature infants; however, feasibility and poor tolerance of feeds may be important obstacles in introducing this strategy to NICU clinical practice. Further research should focus on outcomes, such as body composition and development, and emphasize practical aspects.