Tuesday, August 09, 2016
Impact of human milk fortifiers on the Growth and Tolerance of premature infants
Premature newborns of very low birth weight (VLBW) require nutritional supplements such as human milk fortifiers (HMFs), since they have accentuated energy, protein, and micronutrient requirements. A study published in the Journal of Pediatric Gastroenterology and Nutrition compared the efficacy and safety of standard powdered HMF and a newly formulated liquid HMF containing extensively hydrolysed protein, in premature VLBW infants.
The study was a multicentre, unblinded, randomised, controlled study, which enrolled 147 premature infants in the neonatal intensive care unit, born at less than 33 weeks’ pregnancy and with birth weights ranging from 700 to 1500 grams. The subjects were randomly allocated to receive human milk supplemented with either newly formulated concentrated liquid HMF containing extensively hydrolysed protein (LE–HMF) or a conventional powdered intact protein HMF (PI–HMF). The infants’ weight, length, and head circumference (HC) were measured initially and after 29 days of the intervention period. Blood parameters were assessed at days 1, 15, and 29 of the intervention period.
The weight of the infants in the LE–HMF group increased compared to the infants in the PI–HMF group. Infants in LE–HMF group attained greater linear growth compared to the infants in PI-HMF however; length and HC of the infants were similar in both the groups and were within the growth targets. Stool characteristics such as bloody stools, hard stools, or black stools were similar in both groups. Loose stools were reported by more than half of the infants from both the groups.
Infants in the LE-HMF group had a higher protein intake compared to infants in the PI-HMF group, while the energy intake was similar in both the groups. Blood parameters such as the blood urea nitrogen and prealbumin were higher in the LE-HMF group compared with PI-HMF group. Both the fortifiers were accepted by the infants, and there were no differences in morbidity between the two groups.
The study has some drawbacks. The combined effect of changing protein content and protein type was examined in this study. Examining the effects of any one variable might be beneficial. Some of the infants did not complete the study; this led to a dilution of the results. Infants weighing less than 700 grams were excluded from the study, and hence, the inferences of the study cannot be extended to this vulnerable group. The study sample size was too small and may have contributed towards bias in study outcomes.
The study concluded that both the fortifiers were well accepted, with low morbidity outcomes. Infants fed LE-HMF showed significantly better growth than those fed PI-HMF. Further research involving a larger sample size and focusing on the effects of changing the protein content or protein type in infant formula is warranted.
News source - Kim JH, 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. Journal of pediatric gastroenterology and nutrition. 2015 Dec; 61 (6):665.