|Schanler, Richard - Rich|
Submitted to: Pediatrics
Publication Type: Peer reviewed journal
Publication Acceptance Date: 1/20/1999
Publication Date: N/A
Citation: Interpretive Summary: A major study of feeding strategies in premature infants recently showed that the use of human milk was associated with more profound outcomes than other strategies, such as the time of initiation and method of tube- feeding. Therefore, we wanted to study the effect of diet by measuring the growth, feeding tolerance, health and other characteristics of premature infants fed either fortified human milk or preterm formula. We found improved health outcomes in premature infants fed human milk compared with infants fed formula. We believe that the feeding of fortified human milk should be promoted in premature babies.
Technical Abstract: Background: We evaluated the growth, nutritional status, feeding tolerance, and health of participating premature infants who were fed fortified human milk (FHM) in comparison with those who were fed exclusively preterm formula (PF). Methods: We compared outcomes of premature infants fed >50 ml/kg-1/day-1 of any human milk (averaged throughout the hospitalization) with those of infants fed exclusively PF. Growth, feeding tolerance, and health status were measured daily. Serum indices of nutritional status were measured serially, and 72-hour nutrient balance studies were conducted at 6 and 9 weeks postnatally. Results: A total of 108 infants were fed either >50 ml/kg-1/day-1 human milk (FHM, n=62) or exclusively PF (n=46). Infants fed FHM were discharged earlier (73 vs 88 days), despite significantly slower rates of weight gain (22 vs 26 g/kg-1/day-1), length increment (0.8 vs 1.0), and increment in the sum of 5 skinfold measurements (0.86 vs 1.23mm) than infants fed PF. The incidence of necrotizing enterocolitis (NEC) and late-onset sepsis also was less in the FHM group. There were no differences in any measure of feeding tolerance between groups. The intakes of nitrogen and Cu were higher and Mg and Zn were lower in group FHM vs PF. Fat and energy absorption were lower and P, Zn, and Cu absorption were higher in group FHM vs PF. The postnatal retention (balance) surpassed the intrauterine accretion rate of nitrogen, P, Mg, Zn, and Cu in the FHM group, and of nitrogen, Mg, and Cu in the PF group. Conclusions: The benefits of improved health associated with the feeding of FHM outweighed the slower rate of growth observed, suggesting that the feeding of FHM should be promoted actively in premature infants.