DOES CHOICE OF HUMAN MILK FORTIFIERS AFFECT FEEDING TOLERANCE AND NUTRITION IN PREMATURE INFANTS?

Purpose of study Compare feeding tolerance and nutritional outcomes of preterm infants whose human milk diet was fortified with acidified versus non-acidified Human Milk Fortifier (HMF). Methods used This was an unblinded, randomised controlled, single-centre study of preterm infants born at <35 weeks gestation or <1800 grams who were fed only human milk fortified with either acidified or non-acidified HMF. Feeding intolerance, and laboratory data including serum protein and albumin, pH and bicarbonate were analysed. Feeding intolerance was defined as the point at which feeds were held due to abdominal distention, excessive or bilious gastric residuals, emesis, diarrhoea or bloody stool. Summary of results 80 infants were enrolled in the study; 40 received acidified HMF and 40 received non-acidified HMF added when enteral feeds were at 35% of goal per unit feeding protocol. There were no statistically significant differences between the groups in birth weight or gestational age, days of mechanical ventilation, incidence of NEC or sepsis, length of stay or feeding intolerance. Infants who received acidified HMF vs non-acidified had higher total serum albumin at 7 days (µ ±SD, 3.39±0.34 vs 3.17±0.33, p=0.009) and 14 days (3.39±0.38 vs 3.15±0.33, p=0.014). They also had higher total serum protein at 14 days (5±0.61 vs 4.52±0.56, p=0.001) and 21 days (4.87±0.61 vs 4.56±0.47, p=0.041). Serum bicarbonate levels were lower in the acidified HMF group at 7, 14 and 21 days after fortification (22.15±6.03 vs 25.34±2.64, p=0.004; 23.26±3.75 vs 24.97±2.68, p=0.04; and 23.5±4.64 vs 25.74±2.6, p=0.03 respectively). Conclusions No statistical significance in rates of feeding intolerance were found between preterm infants fed a human milk diet fortified with acidified HMF compared to fortification with non-acidified HMF. Those receiving acidified HMF had higher total serum protein and albumin levels and lower bicarbonate levels with statistical significance, but uncertain clinical significance, between groups.