title: Feeding tolerance in premature infants fed fortified human milk.
abstract: BACKGROUND
  To evaluate feeding tolerance in premature infants immediately after the addition of human milk fortifier (HMF) to their expressed human milk diet.
  
  
  METHODS
  Data on milk intake, feeding tolerance, and related assessments and growth milestones from a prospective study of feeding strategies in premature infants were analyzed. The database was searched for the first day HMF was added to the feeding of infants receiving human milk exclusively. The following assessments were tabulated for the 5 days before and the 5 days after the addition of HMF: milk intake, the number of episodes of abdominal distension, gastric residual volume (GRV) more than 2 ml/kg and more than 50% of the volume fed in the prior 3 hours. bile-stained gastric residual, emesis or regurgitation, blood in the stool, the number of abdominal radiographs, the number of episodes of apnea and bradycardia, changes in findings in the clinical examination, and the number of hours feeding was withheld. The time to achieve full tube feeding, complete oral feeding, and hospital discharge were recorded.
  
  
  RESULTS
  Seventy-six exclusively human milk-fed premature infants (birth weight, 1065+/-18 g; gestational age, 27+/-0.1 weeks; mean +/- SEM) who received HMF beginning 22+/-0.8 days of age were evaluated. There were significant increases in milk intake and in the number of episodes of GRV more than 2 ml/kg and emesis after the addition of HMF. There were no differences in the number of hours feeding was withheld or any other assessment after the addition of HMF. Infants with increases in GRV more than 2 ml/kg and/or emesis after the addition of HMF were not more likely to be delayed in the time to achieve full tube feeding, complete oral feeding, or hospital discharge than infants who did not experience these events.
  
  
  CONCLUSIONS
  These data suggest that, when all feeding and related assessments and the time to achieve important growth milestones are considered, the addition of HMF does not adversely affect the outcome of the premature infant.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Moody
authors.forename: R J
authors.initials: RJ
authors.lastname: Schanler
authors.forename: C
authors.initials: C
authors.lastname: Lau
authors.forename: R J
authors.initials: RJ
authors.lastname: Shulman
mesh_terms: D004750:Enteral Nutrition; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D008895:Milk, Human; D011446:Prospective Studies; D013997:Time Factors