Breast milk targeted fortification and its impact on body composition of preterm infants – an interim analysis

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Submission ID :
ESPR173
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Abstract: :

Background: Human breast milk (BM) requires supplemental fortification to achieve optimal caloric and protein requirements for adequate growth and lean body mass accrual in preterm infants. Targeted fortification utilizes a human milk analyzer (HMA) to assess the exact macronutrient starting point of BM and thus allows for accurate fortifying to targeted goals. There have been no studies to date evaluating targeted BM fortification and its effect on body composition.

Objective: We aim to compare body composition (primary outcome) and overall growth (secondary outcomes) of preterm infants fed target fortified BM versus those fed standard fortified BM. We hypothesize that targeted fortification using an HMA will improve fat-free mass.

Design/Methods: This is a single-center, randomized controlled pilot study of non-growth restricted infants of 26 0/7 - 31 6/7 weeks gestational age (GA) fed mother's and/or donor milk. The targeted fortification (TF) group received fortification based on BM macronutrients as measured by an HMA (MIRIS), while the control fortification (CF) group received fortification based upon BM macronutrient standard assumptions. Both groups were fortified using a minimum amount of cow's milk-based fortifier at 140-160ml/kg/day. Based on weekly growth, and HMA results in the TF group, feeds were then adjusted to meet published ESPGHAN goals by adding extra protein and/or fat modulars, increasing fortifier, and/or adjusting total fluid goal. Fat and fat-free mass were measured by air-displacement plethysmography at discharge (Peapod, COSMED). Birth and discharge growth parameters were converted to z-score equivalents (Fenton 2013) and growth over time was calculated. Weekly caloric intake and nutritional labs were collected, as were basic demographic and morbidity data. Comparisons of categorical data were via Fisher's exact test and continuous data via Student's t test.

Results: 24 infants were enrolled to date (TF n = 12; CF n = 12). While GA was slightly lower in the CF group (28.7±1.8 vs 30.0±1.0 wks; p<0.05), there were no differences in sex, ethnicity, birthweight, and z-score birth measurements. In the TF group, there was a higher discharge fat-free mass (80.1±4.6% vs 76.6±2.3%; p = 0.04) and a corresponding lower fat mass (19.9±4.6% vs 23.4±2.3%; p = 0.04) with more weekly nutritional adjustments (52% vs 16%; p<0.001) and more protein addition (p=0.01). There were no differences between groups in morbidities, caloric intake, nutritional labs, weight gain, z-score discharge measurements, or corrected age at time of discharge.

Conclusion: As per this interim analysis, despite there being no difference in overall growth, there appears to be an association between targeted fortification using weekly HMA, increased protein supplementation, and improved lean body mass at discharge among preterm infants.

University of Massachusetts Medical School- Baystate Children's Hospital
University of Massachusetts Medical School- Baystate Children's Hospital​
University of Massachusetts Medical School- Baystate Children's Hospital
Wake Forest School of Medicine
University of Massachusetts Medical School- Baystate Children's Hospital

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