Nutrient Enrichment of Human Milk with Human and Bovine Milk-Based Fortifiers for Infants Born Kathryn E Hopperton  1 , Deborah L O'Connor  1   2 , Nicole Bando  1 , Aisling M Conway  1 , Dawn V Y Ng  1 , Alex Kiss  3   4 , Jacqueline Jackson  5 , Linh Ly  6 ; OptiMoM Feeding Group; Sharon L Unger  2   5   6   7 Affiliations Expand Affiliations 1 Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada. 2 Department of Nutritional Sciences, University of Toronto, Toronto, Canada. 3 Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 4 Evaluative and Clinical Sciences, Sunnybrook Research Institute and the Institute of Health Policy, Toronto, Canada. 5 Department of Paediatrics, Sinai Health System, Toronto, Canada. 6 Division of Neonatology, The Hospital for Sick Children, Toronto, Canada. 7 Department of Paediatrics, University of Toronto, Toronto, Canada. PMID: 32154499 PMCID: PMC7053578 DOI: 10.1093/cdn/nzz129 Free PMC article Item in Clipboard

Abstract

Background: Bovine milk-based fortifiers (BMBF) have been standard of care for nutrient fortification of feeds for very low birth weight (VLBW) infants, however, there is increasing use of human milk-based fortifiers (HMBF) in neonatal care despite additional costs and limited supporting data. No randomized clinical trial has followed infants fed these fortifiers after initial hospitalization.

Objective: To compare neurodevelopment in infants born weighing <1250 g fed maternal milk with supplemental donor milk and either a HMBF or BMBF.

Methods: This is a follow-up of a completed pragmatic, triple-blind, parallel group randomized clinical trial conducted in Southern Ontario between August 2014 and March 2016 (NCT02137473) with feeding tolerance as the primary outcome. Infants weighing <1250 g at birth were block randomized by an online third-party service to receive either HMBF (n = 64) or BMBF (n = 63) added to maternal milk with supplemental donor milk during hospitalization. Neurodevelopment was assessed at 18-mo corrected age using the Bayley Scales of Infant and Toddler Development, Third Edition. Follow-up was completed in October 2017.

Results: Of the 127 infants randomized, 109 returned for neurodevelopmental assessment. No statistically significant differences between fortifiers were identified for cognitive composite scores [adjusted mean scores 94.7 in the HMBF group and 95.9 in the BMBF group; fully adjusted mean difference, -1.1 (95% CI: -6.5 to 4.4)], language composite scores [adjusted scores 92.4 in the HMBF group and 93.1 in the BMBF; fully adjusted mean difference, -1.2 (-7.5 to 5.1)], or motor composite scores [adjusted scores 95.6 in the HMBF group and 97.7 in the BMBF; fully adjusted mean difference, -1.1 (-6.3 to 4.2)]. There was no difference in the proportion of participants that died or had neurodevelopmental impairment or disability between groups.

Conclusions: Providing HMBF compared with BMBF does not improve neurodevelopmental scores at 18-mo corrected age in infants born <1250 g otherwise fed a human milk diet. This trial was registered at clinicaltrials.gov as NCT02137473.

Keywords: bovine milk-based fortifier; donor milk; human milk; human milk-based fortifier; neurodevelopment; very low birth weight infants.

Copyright © The Author(s) 2019.

Figures

FIGURE 1

Participant flow diagram of very low birth weight infants enrolled in the Optimizing Mothers’ Milk for Preterm Infants Fortifier trial. Infants were randomized to receive a human milk-based fortifier or a bovine milk-based fortifier added to an entirely human milk diet (maternal or donor) during initial hospitalization. Participants returned for neurodevelopmental testing with the Bayley Scales of Infant and Toddler Development, Third Edition at 18-mo corrected age per routine clinical follow-up.