Growth outcomes in preterm neonates receiving human milk fortifiers versus donor milk in a tertiary care hospital: A hospital-based prospective comparative study.
DOI:
https://doi.org/10.51168/16jpvk90Keywords:
Donor milk, growth outcome, human milk fortifier, neonate, preterm, tertiary care hospitalAbstract
Background
Preterm neonates have increased nutritional needs and are at risk of extrauterine growth restriction during neonatal intensive care. Human milk is preferred for enteral feeding; however, unfortified human milk and donor milk alone do not always provide adequate protein, energy, minerals, and micronutrients for optimal postnatal growth.
Objectives: To compare growth outcomes, feeding tolerance, and selected clinical outcomes among preterm neonates receiving human milk with fortifier supplementation versus donor milk in a tertiary care hospital.
Methods
This hospital-based prospective comparative study included 100 preterm neonates admitted to the neonatal intensive care unit and selected by consecutive sampling. Fifty neonates received human milk with fortifier supplementation, and 50 received donor milk as per routine unit feeding protocols. Baseline characteristics, anthropometric growth, feeding tolerance, neonatal morbidities, hospital stay, and discharge nutritional status were compared.
Results
Baseline characteristics were comparable between the human milk fortifier and donor milk groups, including gestational age (31.4 ± 1.8 versus 31.2 ± 1.9 weeks; p=0.59), birth weight (1328 ± 226 versus 1346 ± 238 g; p=0.70), male sex (56.0% versus 52.0%; p=0.69), and small-for-gestational-age status (18.0% versus 22.0%; p=0.62). Neonates receiving human milk fortifier showed earlier regain of birth weight (9.4 ± 2.7 versus 11.6 ± 3.3 days; p<0.001), higher daily weight gain (17.9 ± 3.8 versus 14.5 ± 3.6 g/kg/day; p<0.001), greater length gain (0.93 ± 0.22 versus 0.76 ± 0.20 cm/week; p<0.001), greater head circumference gain (0.78 ± 0.18 versus 0.64 ± 0.17 cm/week; p<0.001), and higher discharge weight (1835 ± 246 versus 1698 ± 235 g; p=0.005). Feed intolerance, necrotizing enterocolitis, late-onset sepsis, hospital stay, and mortality were not significantly different.
Conclusion
Human milk fortifier supplementation was associated with better short-term growth without increasing major complications.
Recommendations
Structured fortification protocols should be adopted with regular anthropometric monitoring and individualized feeding review.
References
1. Brown JVE, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev. 2020;6(6):CD000343. https://doi.org/10.1002/14651858.CD000343.pub4 PMid:35658821 PMCid:PMC7268980
2. Quigley M, Embleton ND, Meader N, McGuire W. Donor human milk for preventing necrotising enterocolitis in very preterm or very low-birthweight infants. Cochrane Database Syst Rev. 2024;9(9):CD002971. https://doi.org/10.1002/14651858.CD002971.pub6 PMid:39239939 PMCid:PMC11378496
3. Ananthan A, Balasubramanian H, Rao S, Patole S. Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis. Adv Nutr. 2020;11(5):1325-1333.
https://doi.org/10.1093/advances/nmaa039 PMid:32277813 PMCid:PMC7490161
4. Hair AB, Blanco CL, Moreira AG, Hawthorne KM, Lee ML, Rechtman DJ, et al. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. J Pediatr. 2014;165(5):915-920. https://doi.org/10.1016/j.jpeds.2014.07.005 PMid:25130571
5. Uthaya S, Jeffries S, Andrzejewska I, Vasu V, Embleton ND, Modi N. Randomised controlled trial of human-derived breast milk fortifier versus bovine milk fortifier on body composition in very preterm babies. Early Hum Dev. 2022;171:105619. https://doi.org/10.1016/j.earlhumdev.2022.105619 PMid:35809401
6. Lucas A, Fewtrell MS, Morley R, Lucas PJ, Baker BA, Lister G, et al. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. Am J Clin Nutr. 1996;64(2):142-151.
https://doi.org/10.1093/ajcn/64.2.142 PMid:8694013
7. Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants. Pediatrics. 2005;116(2):400-406. https://doi.org/10.1542/peds.2004-1974 PMid:16061595
8. Corpeleijn WE, de Waard M, Christmann V, van Goudoever JB, Jansen-van der Weide MC, Kooi EMW, et al. Effect of donor milk on severe infections and mortality in very low-birth-weight infants: The Early Nutrition Study randomized clinical trial. JAMA Pediatr. 2016;170(7):654-661. https://doi.org/10.1001/jamapediatrics.2016.0183 PMid:27135598
9. Griffin IJ, Tancredi DJ, Bertino E, Lee HC, Profit J. Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Arch Dis Child Fetal Neonatal Ed. 2016;101(1):F50-F55. https://doi.org/10.1136/archdischild-2014-308095 PMid:26201534
10. Horbar JD, Ehrenkranz RA, Badger GJ, Edwards EM, Morrow KA, Soll RF, et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000-2013. Pediatrics. 2015;136(1):e84-e92. https://doi.org/10.1542/peds.2015-0129 PMid:26101360
11. Martins EC, Krebs VLJ. Effects of the use of fortified raw maternal milk on very low birth weight infants. J Pediatr (Rio J). 2009;85(2):157-162. https://doi.org/10.2223/JPED.1878 PMid:19319449
12. Quan M, Wang D, Gou L, Sun Z, Ma J, Zhang L, et al. Individualized Human Milk Fortification to Improve the Growth of Hospitalized Preterm Infants. Nutr Clin Pract. 2020;35(4):680-688. https://doi.org/10.1002/ncp.10366 PMid:31268194
13. Kumar M, Upadhyay J, Basu S. Fortification of Human Milk With Infant Formula for Very Low Birth Weight Preterm Infants: A Systematic Review. Indian Pediatr. 2021;58(3):253-258. https://doi.org/10.1007/s13312-021-2166-x PMid:33408285
14. Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association Working Group on Human Milk Fortification. Front Pediatr. 2019;7:76. https://doi.org/10.3389/fped.2019.00076 PMid:30968003 PMCid: PMC6439523
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dr. Shaik Mabbul, Dr. Maddula Ashok, Dr. Sri Harsha Thatikonda (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
