Adjustable fortification of human milk fed to preterm infants: does it make a difference?
Background:Inadequate nutrition leading to growth failure is common among premature infants. Although fortified breast milk (breast milk plus commercially prepared fortifier) is the preferred feeding, nutrient intakes achieved with fortified breast milk fall short of meeting nutrient needs. This is...
| Publicado en: | Journal of Perinatology Vol. 26; no. 10; pp. 614 - 622 |
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| Autores principales: | , , |
| Formato: | clinical trial research Journal Article |
| Publicado: |
Springer Nature
Oct2006
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105951125&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105951125 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07438346 DZF jtl: Journal of Perinatology issn: 07438346 maglogo: Y pubinfo: dt: Oct2006 vid: 26 iid: 10 pid: 2579 pub: Springer Nature place: Dordrecht, <Blank> artinfo: ui: 105951125 105951125 2009302533 10.1038/sj.jp.7211571 NLM16885989 105951125 ppf: 614 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Adjustable fortification of human milk fed to preterm infants: does it make a difference? aug: au: Arslanoglu S Moro GE Ziegler EE sug: subj: Dietary Proteins Administration and Dosage Food, Fortified Infant, Premature Milk, Human Weight Gain Blood Urea Nitrogen Clinical Trials Gestational Age Infant, Newborn Nutritional Requirements Prospective Studies Treatment Outcomes Human Infant, Newborn: birth-1 month ab: Background:Inadequate nutrition leading to growth failure is common among premature infants. Although fortified breast milk (breast milk plus commercially prepared fortifier) is the preferred feeding, nutrient intakes achieved with fortified breast milk fall short of meeting nutrient needs. This is mainly due to inadequate protein content of fortifiers and variability in composition of expressed breast milk.Objective:A new adjustable fortification regimen has been designed to ensure that protein needs of premature infants are met at all times. The new regimen encompasses increasing the amount of fortifier and adding extra protein to breast milk guided by periodic determinations of blood urea nitrogen (BUN). The study tested the hypothesis that infants fed according to the new regimen have higher protein intakes and improved weight gain compared to infants fed according to standard fortification regimen.Methods:In a prospective, controlled trial, preterm infants with birth weights of 600-1750 g and gestational ages between 26 and 34 weeks were fed their own mother's milk or banked donor milk or both. Infants were randomly assigned before 21 days of age to either the new adjustable fortification regimen or the standard regimen. The study period began when feeding volume reached 150 ml/kg/day and ended when infants reached a weight of 2000 g. Standard fortification (STD) consisted in the use of the recommended amount of fortifier. Adjustable fortification (ADJ) consisted in the use, in addition to standard fortification, of extra fortifier and supplemental protein guided by twice-weekly BUN determinations. The primary outcome was weight gain, with serum biochemical indicators and nutrient intakes as secondary outcomes.Results:Thirty-two infants completed the study as planned (16 ADJ, 16 STD). Infants receiving the ADJ regimen had mean protein intakes of 2.9, 3.2 and 3.4 g/kg/day, respectively, in weeks 1, 2 and 3, whereas infants receiving the STD regimen had intakes of 2.9, 2.9, 2.8 g/kg/day, respectively. Infants on the ADJ regimen showed significantly greater gain in weight (17.5+/-3.0 vs 14.4+/-3.0 g/kg/day, P<0.01) and greater gain in head circumference (1.4+/-0.3 vs 1.0+/-0.3; P<0.05) than infants on the STD regimen. Weight and head circumference gain were significantly (P<0.05) correlated with protein intake. No significant correlations were found between growth parameters and intake of fat and energy. There were no significant differences between groups in BUN and other serum chemical values. In the ADJ group, BUN concentrations increased significantly (P<0.001) over time but were not significantly higher than in the STD group.Conclusion:Premature infants managed with the new adjustable fortification regimen had significantly higher weight and head circumference gains than infants managed with standard fortification. Higher protein intake appears to have been primarily responsible for the improved growth with the adjustable regimen. The new fortification method could be a solution to the problem of protein undernutrition among premature infants fed human milk.Journal of Perinatology (2006) 26, 614-621. doi:10.1038/sj.jp.7211571; published online 3 August 2006. pubtype: Academic Journal doctype: clinical trial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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