Author
HAIR, AMY - Children'S Nutrition Research Center (CNRC) | |
HAWTHORNE, KELI - Children'S Nutrition Research Center (CNRC) | |
CHETTA, KATHERINE - Children'S Nutrition Research Center (CNRC) | |
ABRAMS, STEVEN - Children'S Nutrition Research Center (CNRC) |
Submitted to: BMC Research Notes
Publication Type: Peer Reviewed Journal Publication Acceptance Date: 11/8/2013 Publication Date: 11/8/2013 Citation: Hair, A.B., Hawthorne, K.M., Chetta, K.E., Abrams, S.A. 2013. Human milk feeding supports adequate growth in infants </= 1250 grams birth weight. BMC Research Notes. 6:459. Interpretive Summary: Despite current nutritional strategies in the Neonatal Intensive Care Unit, premature infants are at risk for slow growth after they are born. An exclusive human milk-based diet includes mother's own milk supplemented with donor human milk and a fortifier made from donor human milk that provides extra protein and minerals. This diet has been shown to significantly reduce the rate of necrotizing enterocolitis, a devastating intestinal disease, which often leads to complications and poor outcomes. There are concerns that infants may not achieve appropriate growth with this diet. We studied 104 premature infants that received this diet and showed that they had adequate growth when compared to other infants who received standard diets. The diet provided increased amounts of calories and protein earlier compared to standard diets. This study suggests that this feeding approach can be used to help premature infants grow and reduce the rate of intestinal disease. Technical Abstract: Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The objective of this study was to evaluate growth velocities and incidence of extrauterine growth restriction in infants = 1250 grams (g) birth weight (BW) receiving an exclusive human milk-based diet with early and rapid advancement of fortification using a donor human milk derived fortifier. In a single center, prospective observational cohort study, preterm infants weighing = 1250 g BW were fed an exclusive human milk-based diet until 34 weeks postmenstrual age. Human milk fortification with donor human milk derived fortifier was started at 60 mL/kg/d and advanced to provide 6 to 8 additional kilocalories per ounce (or 0.21 to 0.28 kilocalories per gram). Data for growth were compared to historical growth standards and previous human milk-fed cohorts. We consecutively evaluated 104 infants with mean gestational age of 27.6 +/- 2.0 weeks and BW of 913 +/- 181 g (mean +/- standard deviation). Weight gain was 24.8 +/- 5.4 g/kg/day with length 0.99 +/- 0.23 cm/week and head circumference 0.72 +/- 0.14 cm/week. There were 3 medical NEC cases and 1 surgical NEC case. 22 infants (21%) were small for gestational age at birth. Overall, 45 infants (43%) had extrauterine growth restriction. Weight velocity was affected by day of fortification (p = 0.005) and day of full feeds (p = 0.02). Our cohort had significantly greater growth in weight and length compared to previous entirely human milk-fed cohorts. A feeding protocol for infants = 1250 g BW providing an exclusive human milk-based diet with early and rapid advancement of fortification leads to growth meeting targeted standards with a low rate of extrauterine growth restriction. Consistent nutritional policies using this approach may be considered for this population. |