Multicomponent fortification of human breast milk for preterm infants following hospital discharge

McCormick FM, Henderson G, Fahey T, McGuire W

Published Online:

July 7, 2010

Preterm infants are often much smaller than term infants by the time that they are discharged home from hospital. This review attempted to identify trials that evaluated whether feeding these infants with breast milk fortified with added nutrients rather than unfortified breast milk would increase growth rates and benefit development. Only one small trial (in which 39 infants participated) of this intervention was found. This trial did provide some evidence that multinutrient fortification increases growth rates during infancy. Further trials are needed to confirm this finding and to determine long term effects on growth and development .

Abstract (click to read)

Background:

Preterm infants are usually growth restricted at hospital discharge. Feeding preterm infants after hospital discharge with multinutrient fortified breast milk rather than unfortified breast milk may facilitate more rapid catch-up growth and improve neurodevelopmental outcomes.

Objectives:

To determine the effect of feeding with multinutrient fortified human breast milk versus unfortified breast milk on growth and development in preterm or low birth weight infants following hospital discharge.

Search strategy:

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2010), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), CINAHL (1982 to April 2010), conference proceedings, and previous reviews.

Selection criteria:

Randomised or quasi-randomised controlled trials that compared feeding preterm infants following hospital discharge with multinutrient fortified breast milk compared with unfortified human breast milk.

Data collection and analysis:

The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two review authors.

Main results:

One small trial (N = 39) was identified. Multinutrient fortification of breast milk for 12 weeks after hospital discharge resulted in higher rates of growth during infancy. At 12 months corrected age, weight (mean difference 1187g, 95% confidence interval (CI) 259, 2115 g), length (3.8 cm, 95%CI 1.2, 6.4 cm) and head circumference (1.0 cm, 95%CI 0.1, 1.9 cm) were statistically significantly greater in the intervention group. No evidence of an effect on neurodevelopmental assessments at 18 months corrected age was found.

Authors' conclusions:

The limited available data suggest that feeding preterm infants following hospital discharge with multinutrient fortified breast milk compared with unfortified breast milk increases growth rates during infancy. The importance of these effects on long-term growth and development is unclear and deserves further assessment in randomised controlled trials. Since fortifying breast milk for infants fed directly from the breast is logistically difficult and has the potential to interfere with breast feeding, it is important to determine if mothers would support further trials of this intervention.

This record should be cited as:

McCormick FM, Henderson G, Fahey T, McGuire W. Multinutrient fortification of human breast milk for preterm infants following hospital discharge. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD004866. DOI: 10.1002/14651858.CD004866.pub3

Assessed as up to date:

May 14, 2010

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Feeding the low birthweight infant > Comparison of whole diets

Complementary & alternative medicine > Neonatal care > Feeding the low birthweight infant

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Multicomponent fortification of human breast milk for preterm infants following hospital discharge

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