The Use of Early Fortification in Preterm Infants
Early Fortification to Shorten Birth Weight Recovery Time in Very Preterm or Very Low Birth Weight Infants
Very premature or very low birth weight (VLBW) infants are at risk of suboptimal growth after birth, making adequate nutrition essential. Breast milk alone is insufficient to meet the nutritional needs of premature infants, so fortification is added to breast milk to support catch-up growth. Standard human milk fortification (HMF) is typically started when the feeding volume reaches 100 ml/kg/day, but research suggests that early HMF administration can increase protein intake sooner without negative effects on the infant. Early HMF administration didn't increase the incidence of food intolerance and necrotizing enterocolitis (NEC). Other studies have shown that early fortification increases the rate of early weight gain without increasing the incidence of complications. There is no research in Indonesia comparing the duration of regaining birth weight between early HMF and standard HMF. This study aims to determine the difference in the duration of regaining birth weight in very premature or VLBW infants given early HMF versus standard HMF. The research method is a prospective, randomized, double-blind preliminary study comparing early HMF administration (when feeding volume reached 30 ml/kg/day) with standard HMF (when feeding volume reached 100 ml/kg/day).
Přehled studie
Postavení
Intervence / Léčba
Typ studie
Zápis (Aktuální)
Fáze
- Nelze použít
Kontakty a umístění
Studijní místa
-
-
DKI Jakarta
-
Jakarta Pusat, DKI Jakarta, Indonésie, 10430
- Cipto Mangunkusumo Hospital
-
-
Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- Very preterm infants (gestational age 28 to <32 weeks) or very low birth weight infants (birth weight 1000 to <1500 grams)
- Infants receiving at least 50% of their daily enteral needs from breast milk
- Infants whose parents provided written informed consent to participate in the study
Exclusion Criteria:
- Infants with major congenital abnormalities
- Infants with grade 2 or grade 3 NEC or spontaneous intestinal perforation (SIP) before the intervention
- Infants who had already achieved return to birth weight (RTBW) before initiation of the intervention
- Infants with insufficient breast milk availability to provide ≥50% of their daily enteral requirements before enrollment
- Infants born to mothers with medical conditions that precluded breastfeeding
- Infants with known cow's milk protein allergy before initiation of the intervention
- Infants who died before initiation of the intervention
- Parents who withdrew informed consent
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Podpůrná péče
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Dvojnásobek
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
|---|---|
|
Experimentální: Early Fortification Group
Participants were given early fortification when the feeding volume reached 30 ml/kg/day |
In the early fortification group, 1 sachet of HMF was added to 30 ml of breast milk for the first 24 hours. If the feeding tolerance was good, 1 sachet of HMF was then mixed into 25 ml of breast milk. |
|
Experimentální: Standard Fortification Group
Participants were given standard fortification when the feeding volume reached 100 ml/kg/day |
In the standard fortification group, 1 sachet of HMF was mixed into 25 ml of breast milk starting from the first day of HMF administration. |
Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Return to birth weight
Časové okno: Body weight will be measured daily from birth until the day the infant first reaches their birth weight. The assessment period is expected to last up to 3 weeks after birth.
|
The first day the infants reached their birth weight again |
Body weight will be measured daily from birth until the day the infant first reaches their birth weight. The assessment period is expected to last up to 3 weeks after birth.
|
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Number of Participants with Feeding Intolerance
Časové okno: Feeding intolerance will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
|
Feeding intolerance was defined as inability to tolerate enteral feeding, characterized by a gastric residual volume greater than 50% (with or without regurgitation), vomiting, abdominal distension, decreased frequency of bowel movements, and disruption of the feeding plan. |
Feeding intolerance will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
|
|
Number of Participants with Electrolyte Imbalances
Časové okno: Electrolytes will be assessed once during intervention. Blood sampling will be scheduled by the attending physician. The intervention period starts with HMF administration and ends when birth weight is regained, expected within 3 weeks after birth.
|
Electrolyte imbalance was identified when serum levels fell below institutional laboratory reference ranges, with assessments performed for all study subjects. |
Electrolytes will be assessed once during intervention. Blood sampling will be scheduled by the attending physician. The intervention period starts with HMF administration and ends when birth weight is regained, expected within 3 weeks after birth.
|
|
Number of Participants with Necrotizing Enterocolitis
Časové okno: Necrotizing enterocolitis will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
|
Necrotizing enterocolitis was defined as a disorder of the intestinal mucosa, clinically manifested by feeding intolerance, bloody stools, and possibly accompanied by changes in abdominal skin color, supported by abdominal X-ray findings consistent with necrotizing enterocolitis. |
Necrotizing enterocolitis will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
|
Spolupracovníci a vyšetřovatelé
Sponzor
Vyšetřovatelé
- Vrchní vyšetřovatel: Putri MT Marsubrin, MD, PhD, FKUI RSCM
Publikace a užitečné odkazy
Obecné publikace
- Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawoger R, Kiechl-Kohlendorfer U, Chan GM, Blanco CL, Abrams S, Cotten CM, Laroia N, Ehrenkranz RA, Dudell G, Cristofalo EA, Meier P, Lee ML, Rechtman DJ, Lucas A. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010 Apr;156(4):562-7.e1. doi: 10.1016/j.jpeds.2009.10.040. Epub 2009 Dec 29.
- Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011 Jul;41(6):158-76. doi: 10.1016/j.cppeds.2011.01.001.
- Shah SD, Dereddy N, Jones TL, Dhanireddy R, Talati AJ. Early versus Delayed Human Milk Fortification in Very Low Birth Weight Infants-A Randomized Controlled Trial. J Pediatr. 2016 Jul;174:126-131.e1. doi: 10.1016/j.jpeds.2016.03.056. Epub 2016 Apr 23.
- Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gulmezoglu AM. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019 Jan;7(1):e37-e46. doi: 10.1016/S2214-109X(18)30451-0. Epub 2018 Oct 30.
- Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, Okwaraji YB, Mahanani WR, Johansson EW, Lavin T, Fernandez DE, Dominguez GG, de Costa A, Cresswell JA, Krasevec J, Lawn JE, Blencowe H, Requejo J, Moran AC. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023 Oct 7;402(10409):1261-1271. doi: 10.1016/S0140-6736(23)00878-4.
- Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database Syst Rev. 2020 Jul 29;7(7):CD013392. doi: 10.1002/14651858.CD013392.pub2.
- Joosten K, Vermeulen M. Principles of feeding the preterm infant. Clin Nutr ESPEN. 2024 Feb;59:320-327. doi: 10.1016/j.clnesp.2023.12.016. Epub 2023 Dec 20. No abstract available.
- Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr. 2024 Jun;15(6):100220. doi: 10.1016/j.advnut.2024.100220. Epub 2024 Apr 24.
- Alizadeh Taheri P, Sajjadian N, Asgharyan Fargi M, Shariat M. Is early breast milk fortification more effective in preterm infants?: a clinical trial. J Perinat Med. 2017 Nov 27;45(8):953-957. doi: 10.1515/jpm-2015-0375.
- Gupta G, Murugesan A, Thanigainathan S, Adhisivam B. Does Early Fortification of Human Milk Decrease Time to Regain Birth Weight as Compared to Late Fortification Among Preterm Infants? - A Randomized Controlled Trial. Indian J Pediatr. 2025 Jun;92(6):592-597. doi: 10.1007/s12098-024-05066-5. Epub 2024 Feb 28.
- Marsubrin PMT, Rohsiswatmo R, Sjarif DR. Preterm human milk composition and dietary intake of breastfeeding mothers in the Indonesian population. Paediatr Indones. 2021;61:20-24.
- Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open. 2020 Sep 15;4(1):e000740. doi: 10.1136/bmjpo-2020-000740. eCollection 2020.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Primární dokončení (Aktuální)
Dokončení studie (Aktuální)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další identifikační čísla studie
- 24-06-0986
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .