Growth and Clinical Outcomes of Very Low-Birth-Weight Infants Receiving Acidified vs Nonacidified Liquid Human Milk Fortifiers
Journal
Nutrition in Clinical Practice
Journal Volume
36
Journal Issue
6
Pages
1304-1311
Date Issued
2021
Author(s)
Cordova E.G
Soldateli B
Rosner B
Drouin K
Davitt E
Pepin H.L
Ellard D.M
Bell K
Belfort M.B.
Abstract
Background: Liquid human milk fortifiers are used commonly in neonatal intensive care. Use of an acidified HMF (A-HMF) is associated with transient metabolic acidosis, but whether growth outcomes differ between infants fed A-HMF vs nonacidified HMF (NA-HMF) remains unknown. Methods: Retrospective cohort study of 255 infants born at <33 weeks' gestation and ≤1500 g who were receiving ≥75% fortified human milk on day of life 14, in a level III neonatal intensive care unit (NICU) from May 2015 to December 2018. Infants born before October 2017 (n = 165) received A-HMF, whereas infants born after October 2017 (n = 90) received NA-HMF. We used logistic regression to estimate odds of metabolic acidosis (serum bicarbonate <16 mEq/L in the first 21 days of life) in infants receiving A-HMF vs NA-HMF and linear mixed models to compare the mean size at discharge (weight, length, head z-scores) by HMF type. We adjusted models for confounders and accounted for the nonindependence of multiple births. Results: Median gestational age was 28.7 weeks (range, 22.6–32.9) and birth weight 1.1 kg (range, 0.4–1.5). Infants receiving A-HMF had higher adjusted odds of metabolic acidosis than infants receiving NA–HMF (adjusted odds ratio, 2.7; 95% CI, 1.2–6.2). There were no differences between groups in size z-scores at discharge. Conclusions: In human-milkfed, very-low-birthweight infants, fortification with liquid A-HMF may contribute to metabolic acidosis in the first month of life, but this practice does not appear to impair growth through NICU discharge, compared with fortification with NA-HMF. © 2020 American Society for Parenteral and Enteral Nutrition
Subjects
growth; head circumference; human milk fortifier; length; metabolic acidosis; very low birth weight infant; weight
Other Subjects
bicarbonate; acidification; adult; Article; bicarbonate blood level; birth weight; body weight; body weight gain; breast milk; cohort analysis; electronic medical record; enteric feeding; female; follow up; gestational age; growth; head circumference; hospitalization; human; infant; infant feeding; length of stay; major clinical study; male; maternal age; metabolic acidosis; necrotizing enterocolitis; neonatal intensive care unit; parenteral nutrition; retrospective study; risk factor; sensitivity analysis; very low birth weight; fortified food; newborn; prematurity; very low birth weight; Food, Fortified; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Milk, Human; Retrospective Studies; Weight Gain
Type
journal article