Evaluation of A Concentrated Preterm Formula as a Liquid Human Milk Fortifier in Preterm Babies at Increased Risk of Feed Intolerance

Anish Pillai, Susan Albersheim, Julie Matheson, Vikki Lalari, Sylvia Wei, Sheila M Innis, Rajavel Elango, Anish Pillai, Susan Albersheim, Julie Matheson, Vikki Lalari, Sylvia Wei, Sheila M Innis, Rajavel Elango

Abstract

There are concerns around safety and tolerance of powder human milk fortifiers to optimize nutrition in preterm infants. The purpose of this study was to evaluate the tolerance and safety of a concentrated preterm formula (CPF) as a liquid human milk fortifier (HMF) for premature infants at increased risk of feeding intolerance. We prospectively enrolled preterm infants over an 18-month period, for whom a clinical decision had been made to add CPF to human milk due to concerns regarding tolerance of powder HMF. Data on feed tolerance, anthropometry, and serum biochemistry values were recorded. Serious adverse events, such as mortality, necrotizing enterocolitis (NEC), and sepsis, were monitored. A total of 29 babies received CPF fortified milk during the study period. The most common indication for starting CPF was previous intolerance to powder HMF. Feeding intolerance was noted in 4 infants on CPF. The growth velocity of infants was satisfactory (15.9 g/kg/day) after addition of CPF to feeds. The use of CPF as a fortifier in preterm babies considered at increased risk for feed intolerance seems well tolerated and facilitates adequate growth. Under close nutrition monitoring, this provides an additional option for human milk fortification in this challenging subgroup of preterm babies, especially in settings with limited human milk fortifier options.

Keywords: formula; fortification; human milk; premature.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of study participants.

References

    1. Agostoni C., Buonocore G., Carnielli V.P., De Curtis M., Darmaun D., Decsi T., Domellöf M., Embleton N.D., Fusch C., et al. Enteral nutrient supply for preterm infants: Commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2010;50:85–91. doi: 10.1097/MPG.0b013e3181adaee0.
    1. Eidelman A.I. Breastfeeding and the use of human milk: An analysis of the American Academy of Pediatrics 2012 Breastfeeding Policy Statement. Breastfeed Med. 2012;7:323–324. doi: 10.1089/bfm.2012.0067.
    1. ESPGHAN Committee on Nutrition. Agostoni C., Braegger C., Decsi T., Kolacek S., Koletzko B., Michaelsen K.F., Mihatsch W., Moreno L.A., Puntis J., et al. Breast-feeding: A commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 2009;49:112–125. doi: 10.1097/MPG.0b013e31819f1e05.
    1. Lucas A., Cole T.J. Breast milk and neonatal necrotising enterocolitis. Lancet. 1990;336:1519–1523. doi: 10.1016/0140-6736(90)93304-8.
    1. Lucas A., Morley R., Cole T.J., Lister G., Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm. Lancet. 1992;339:261–264. doi: 10.1016/0140-6736(92)91329-7.
    1. McGuire W., Anthony M.Y. Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: Systematic review. Arch. Dis. Child. Fetal Neonatal Ed. 2003;88:11–14. doi: 10.1136/fn.88.1.F11.
    1. Sisk P.M., Lovelady C.A., Dillard R.G., Gruber K.J., O’Shea T.M. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007;27:428–433. doi: 10.1038/sj.jp.7211758.
    1. Bauer J., Gerss J. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin. Nutr. 2011;30:215–220. doi: 10.1016/j.clnu.2010.08.003.
    1. Arslanoglu S., Moro G.E., Ziegler E.E., The Wapm Working Group on Nutrition, null Optimization of human milk fortification for preterm infants: New concepts and recommendations. J. Perinat. Med. 2010;38:233–238. doi: 10.1515/jpm.2010.073.
    1. Hawthorne K.M., Abrams S.A. Safety and efficacy of human milk fortification for very-low-birthweight infants. Nutr. Rev. 2004;62:482–485. doi: 10.1111/j.1753-4887.2004.tb00020.x.
    1. Kuschel C.A., Harding J.E. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane. Database Syst. Rev. 2004 doi: 10.1002/14651858.CD000343.pub2.
    1. Maggio L., Costa S., Gallini F. Human milk fortifiers in very low birth weight infants. Early Hum. Dev. 2009;85:S59–S61. doi: 10.1016/j.earlhumdev.2009.08.018.
    1. Brown J.V.E., Embleton N.D., Harding J.E., McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane. Database Syst. Rev. 2016 doi: 10.1002/14651858.CD000343.pub3.
    1. Schanler R.J. Suitability of human milk for the low-birthweight infant. Clin. Perinatol. 1995;22:207–222. doi: 10.1016/S0095-5108(18)30309-9.
    1. Schanler R.J., Abrams S.A. Postnatal attainment of intrauterine macromineral accretion rates in low birth weight infants fed fortified human milk. J. Pediatr. 1995;126:441–447. doi: 10.1016/S0022-3476(95)70465-5.
    1. Arslanoglu S., Bertino E., Coscia A., Tonetto P., Giuliani F., Moro G.E. Update of adjustable fortification regimen for preterm infants: A new protocol. J. Biol. Regul. Homeost. Agents. 2012;26:65–67.
    1. Arslanoglu S., Moro G.E., Ziegler E.E. Adjustable fortification of human milk fed to preterm infants: Does it make a difference? J. Perinatol. 2006;26:614–621. doi: 10.1038/sj.jp.7211571.
    1. Sullivan S., Schanler R.J., Kim J.H., Patel A.L., Trawöger R., Kiechl-Kohlendorfer U., Chan G.M., Blanco C.L., Abrams S., Cotten C.M., et al. 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;156:562–567. doi: 10.1016/j.jpeds.2009.10.040.
    1. Pearson F., Johnson M.J., Leaf A.A. Milk osmolality: Does it matter? Arch. Dis. Child. Fetal Neonatal Ed. 2013;98:166–169. doi: 10.1136/adc.2011.300492.
    1. Goldblum O.M., Holzman I.R., Fisher S.E. Intragastric feeding in the neonatal dog. Its effect on intestinal osmolality. Am. J. Dis. Child. 1981;135:631–633. doi: 10.1001/archpedi.1981.02130310037013.
    1. Schmid H.R., Ehrlein H.J. Effects of enteral infusion of hypertonic saline and nutrients on canine jejunal motor patterns. Dig. Dis. Sci. 1993;38:1062–1072. doi: 10.1007/BF01295722.
    1. Srinivasan L., Bokiniec R., King C., Weaver G., Edwards A.D. Increased osmolality of breast milk with therapeutic additives. Arch. Dis. Child. Fetal Neonatal Ed. 2004;89:F514–F517. doi: 10.1136/adc.2003.037192.
    1. Palcich G., de Moraes Gillio C., Aragon-Alegro L.C., Pagotto F.J., Farber J.M., Landgraf M., Destro M.T. Enterobacter sakazakii in dried infant formulas and milk kitchens of maternity wards in São Paulo, Brazil. J. Food Prot. 2009;72:37–42. doi: 10.4315/0362-028X-72.1.37.
    1. Stanger J., Zwicker K., Albersheim S., Murphy J.J. Human milk fortifier: An occult cause of bowel obstruction in extremely premature neonates. J. Pediatr. Surg. 2014;49:724–726. doi: 10.1016/j.jpedsurg.2014.02.054.
    1. Flikweert E.R., La Hei E.R., De Rijke Y.B., Van de Ven K. Return of the milk curd syndrome. Pediatr. Surg. Int. 2003;19:628–631. doi: 10.1007/s00383-003-0968-7.
    1. Murase M., Miyazawa T., Taki M., Sakurai M., Miura F., Mizuno K., Itabashi K., Toki A. Development of fatty acid calcium stone ileus after initiation of human milk fortifier. Pediatr. Int. 2013;55:114–116. doi: 10.1111/j.1442-200X.2012.03630.x.
    1. Willeitner A., Anderson M., Lewis J. Highly Concentrated Preterm Formula as an Alternative to Powdered Human Milk Fortifier: A Randomized Controlled Trial. J. Pediatr. Gastroenterol. Nutr. 2017;65:574–578. doi: 10.1097/MPG.0000000000001638.
    1. Tsang R.C., Uauy R., Koletzko B., Zlotkin S. Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. Digital Educational Publishing, Inc.; Cincinnati, OH, USA: 2005.
    1. Boyce C., Watson M., Lazidis G., Reeve S., Dods K., Simmer K., McLeod G. Preterm human milk composition: A systematic literature review. Br. J. Nutr. 2016;116:1033–1045. doi: 10.1017/S0007114516003007.
    1. Gidrewicz D.A., Fenton T.R. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014;14:216. doi: 10.1186/1471-2431-14-216.
    1. Fenton T.R. A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr. 2003;3:13. doi: 10.1186/1471-2431-3-13.
    1. Fenton T.R., Kim J.H. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. doi: 10.1186/1471-2431-13-59.
    1. Fenton T.R., Sauve R.S. Using the LMS method to calculate z-scores for the Fenton preterm infant growth chart. Eur. J. Clin. Nutr. 2007;61:1380–1385. doi: 10.1038/sj.ejcn.1602667.
    1. Patel A.L., Engstrom J.L., Meier P.P., Kimura R.E. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants. Pediatrics. 2005;116:1466–1473. doi: 10.1542/peds.2004-1699.
    1. Patel A.L., Engstrom J.L., Meier P.P., Jegier B.J., Kimura R.E. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants. J. Perinatol. 2009;29:618–622. doi: 10.1038/jp.2009.55.
    1. Bell M.J., Ternberg J.L., Feigin R.D., Keating J.P., Marshall R., Barton L., Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann. Surg. 1978;187:1–7. doi: 10.1097/00000658-197801000-00001.
    1. Ehrenkranz R.A., Walsh M.C., Vohr B.R., Jobe A.H., Wright L.L., Fanaroff A.A., Wrage L.A., Poole K. National Institutes of Child Health and Human Development Neonatal Research Network Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005;116:1353–1360. doi: 10.1542/peds.2005-0249.
    1. International Committee for the Classification of Retinopathy of Prematurity The International Classification of Retinopathy of Prematurity revisited. Arch. Ophthalmol. 2005;123:991–999. doi: 10.1001/archopht.123.7.991.
    1. Abdallah E.A.A., Said R.N., Mosallam D.S., Moawad E.M.I., Kamal N.M., Fathallah M.G.E.-D. Serial serum alkaline phosphatase as an early biomarker for osteopenia of prematurity. Medicine (Baltimore) 2016;95:e4837. doi: 10.1097/MD.0000000000004837.
    1. Kim J.H., Chan G., Schanler R., Groh-Wargo S., Bloom B., Dimmit R., Williams L., Baggs G., Barrett-Reis B. Growth and tolerance of preterm infants fed a new extensively hydrolyzed liquid human milk fortifier. J. Pediatr. Gastroenterol. Nutr. 2015;61:665–671. doi: 10.1097/MPG.0000000000001010.
    1. Fanaro S. Feeding intolerance in the preterm infant. Early Hum. Dev. 2013;89(Suppl. 2):S13–S20. doi: 10.1016/j.earlhumdev.2013.07.013.
    1. Thoene M., Lyden E., Weishaar K., Elliott E., Wu R., White K., Timm H., Anderson-Berry A. Comparison of a powdered, acidified liquid, and non-acidified liquid human milk fortifier on clinical outcomes in premature infants. Nutrients. 2016;8:451. doi: 10.3390/nu8080451.
    1. Mukhopadhyay K., Narnag A., Mahajan R. Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies: A randomized controlled trial. Indian Pediatr. 2007;44:286–290.
    1. Villar J., Giuliani F., Barros F., Roggero P., Coronado Zarco I.A., Rego M.A.S., Ochieng R., Gianni M.L., Rao S., Lambert A., et al. Monitoring the postnatal growth of preterm infants: A paradigm change. Pediatrics. 2018;141 doi: 10.1542/peds.2017-2467.
    1. Moya F., Sisk P.M., Walsh K.R., Berseth C.L. A new liquid human milk fortifier and linear growth in preterm infants. Pediatrics. 2012;130:e928–e935. doi: 10.1542/peds.2011-3120.
    1. Hintz S.R., Kendrick D.E., Stoll B.J., Vohr B.R., Fanaroff A.A., Donovan E.F., Poole W.K., Blakely M.L., Wright L., Higgins R., et al. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics. 2005;115:696–703. doi: 10.1542/peds.2004-0569.
    1. Nicholl R.M., Gamsu H.R. Changes in growth and metabolism in very low birthweight infants fed with fortified breast milk. Acta. Paediatr. 1999;88:1056–1061. doi: 10.1111/j.1651-2227.1999.tb00987.x.
    1. Ehrenkranz R.A., Dusick A.M., Vohr B.R., Wright L.L., Wrage L.A., Poole W.K. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253–1261. doi: 10.1542/peds.2005-1368.
    1. Erickson T., Gill G., Chan G.M. The effects of acidification on human milk’s cellular and nutritional content. J. Perinatol. 2013;33:371–373. doi: 10.1038/jp.2012.117.
    1. Thoene M., Hanson C., Lyden E., Dugick L., Ruybal L., Anderson-Berry A. Comparison of the effect of two human milk fortifiers on clinical outcomes in premature infants. Nutrients. 2014;6:261–275. doi: 10.3390/nu6010261.
    1. Manz F., Kalhoff H., Remer T. Renal acid excretion in early infancy. Pediatr. Nephrol. 1997;11:231–243. doi: 10.1007/s004670050270.

Source: PubMed

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