GROWTH OUTCOMES IN VERY LOW BIRTH WEIGHT INFANTS WITH EARLY FORTIFICATION OF HUMAN MILK
Pearce Margaret MD¹, Susan Mathieson RD, CSP, CLC¹, H. Alcala PhD, MPH, CPH¹, Shanthy Sridhar MD¹
¹Department of Pediatrics, Division of Neonatology. Stony Brook Children's,
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
Background: Extrauterine growth in very low birth weight (VLBW) infants is inferior to intrauterine growth which contributes to morbidity and mortality. Early enteral nutrition, particularly human milk, promotes gut maturation and decreases the risk of necrotizing enterocolitis (NEC) and cholestasis. Higher protein and energy intake improves long term neurodevelopmental outcomes. Our study hypothesized that earlier fortification improves growth velocities and z-scores.
Methods: Retrospective study to compare growth outcomes with early (40-60 ml/kg/day) and late (>80 ml/kg/day) fortification of human milk in VLBW infants who received breast milk for the first 28 days of life. Congenital anomalies and bowel resections were excluded. 70 subject per group were included to detect significance with 80% power and 2-tailed alpha of 0.05.
Results: Gestational ages ranged from 23 6/7 to 35 3/7 weeks with average birth weights of 1037g and 1102g, respectively. Birth to 6 months corrected age showed significant improvement in weight and head circumference velocities (weight mean diff 0.016 kg/wk, p 0.05; HC mean diff 0.058 cm/wk, p 0.01). All growth velocities from birth to discharge and discharge to 6 months corrected age trended towards improved growth outcomes in the early fortification group.
Conclusion: Early fortification showed a significant improvement in weight and head circumference growth velocities from birth to 6 months corrected age. There was a trend towards improved growth outcomes in all three parameters. Further statistical analysis is in process to compare z-scores, feeding characteristics, subgroups, and outcomes.
