|Schanler, Richard - Rich|
Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer reviewed journal
Publication Acceptance Date: 1/20/2000
Publication Date: N/A
Citation: Interpretive Summary: It is widely known today that mother's milk is preferable to formula because the former provides an array of special health benefits. Because premature infants need extra nutrients that human milk alone cannot provide, commercial fortifiers are available. Some doctors are reluctant to use them due to a concern over potential feeding intolerance. We evaluated this issue in a large group of premature infants, some of whom received only mother's milk, while others received it with fortifier. Our results showed that fortifier does not affect feeding tolerance. The increased emesis observed stemmed from doubled milk intake, which did not slow the baby's progress toward achieving full oral feeding. This is a valuable study whose results will be helpful to countless clinicians, because it clarifies an issue with broad impact on important outcomes involving adequate infant nutrition and length of hospital stay.
Technical Abstract: Objective: To evaluate feeding tolerance, and the achievement of nutritional milestones in premature infants after the addition of human milk fortifier (HMF) to their expressed human milk diet. The following data from a 5-year, prospective study of the time of initiation and method of tube-feeding in premature infants were evaluated 5 d before and the 5 d after adding HMF: milk intake, episodes of emesis, abdominal distention, hours feeding was withheld, stool frequency, abdominal radiographs, and number of times gastric residual volume (GRV) was greater than or equal to 0 mL/kg-1, greater than or equal to 2 mL/kg-1, and greater than 50% of the previous 3 hours of feeding. Seventy-six exclusively human milk-fed infants who received HMF were evaluated. There were significant increases in the number of episodes of emesis, GRV greater than or equal to 2 mL/kg-1, and number of stools during the 5 days after adding HMF. However, milk intake doubled after adding HMF, when compared with the previous 5-day period. When adjusted for the difference in milk intake, the increases in emesis, GRV, and stool frequency were not significant. Furthermore, infants with increases in emesis and GRV greater than or equal to 2 mL/kg-1 after adding HMF were not delayed in achieving full tube-feeding, all-oral feeding, or hospital discharge, compared with infants not experiencing increases in emesis and GRV. These data suggest that changes in feeding tolerance in human milk-fed premature infants after the addition of HMF become insignificant when adjusted for increased milk intake. More importantly, HMF does not delay the achievement of full tube-feeding, all-oral feeding, or hospital discharge.