Concentrated high-protein liquid fortifier boosts ICU babies’ growth

By Piriya Mahendra, medwireNews Reporter

Breast milk fortified with an ultraconcentrated high-protein liquid increases growth and is well-tolerated by preterm babies in comparison with a lower-protein enriched powder alternative, research shows.

The study showed that an ultraconcentrated liquid human milk fortifier (LMHF) supported better growth in human breast milk-fed premature babies in a neonatal intensive care unit (NICU) than a powdered fortifier used currently.

The trial involved 146 preterm infants with a gestational age of 23.7-30.4 weeks and a birthweight of 530-1230 g who were randomly allocated to receive either powder HMF (control) or LHMF for 28 days, hospital discharge, or termination of fortified breast milk feedings, whichever occurred first. The authors say LHMF provided 20% more protein than HMF did.

As reported in Pediatrics, there were no significant differences in the rates of mean weight gain between the LHMF and control groups in the primary or efficiency analyses. However, mean length growth rate, also known as linear growth, was significantly higher in the LHMF group compared with the control group in the primary analysis, at 0.16 cm per day versus 0.14 cm per day.

Linear growth was also significantly higher in the LHMF versus control group in the efficacy analysis, at 0.17 cm per day versus 0.14 cm per day.

Although there were no significant differences in achieved weight, length, or head circumference on day 14, weight and length were significantly higher for infants in the LHMF group compared with the control group on day 28, at 1770 g versus 1670 g.

The overall incidence of confirmed sepsis was 12% and necrotizing enterocolitis (NEC) was 3%. There was no significant difference between the groups in NEC or sepsis incidence.

The study findings come in light of safety guidelines issued by the Academy of Nutrition and Dietetics and the Centers for Disease Control and Prevention that recommend sterile liquid products are used instead of powdered products for premature or immune-compromised infants in the NICU.

"Although liquid fortifiers are already recognized as the new standard of care, this is the first study to demonstrate the nutritional and safety benefits of ultra-concentrated liquid human milk fortifiers over powdered versions," explained co-author Carol Berseth (Mead Johnson Nutrition, Indiana, USA) in a press statement.

The babies in the control arm of the study received four packets of HMF powder mixed with 100 mL of breast milk daily. The babies who received LHMF received five vials of LHMF mixed with 100 mL of breast milk daily.

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