Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies: a randomized controlled trial.
OBJECTIVE
To study the effects of human milk fortification on short term growth and biochemical parameters in preterm very low birth weight (VLBW) appropriate for gestation (AGA) and small for gestation (SGA) babies.


METHODS
Prospective, randomized controlled trial.


METHODS
Level III neonatal unit.


METHODS
Preterm infants weighing < or = 1500 grams and < or = 34 weeks of gestation born between March 2001 to June 2002.


METHODS
Babies (n =166) were randomized in two groups either to get fortified human milk or exclusive human milk along with mineral and vitamin supplementation when feed volume reached 150 mL/Kg/day. Fortification was done with a powdered fortifier added in expressed breast milk and continued till the baby reached 2 Kg or full breast feeds. Primary outcome measures were Short-term growth (daily weight, length and head circumference (HC) weekly) till discharge or 2 Kg.


RESULTS
Fortification (n = 85, birth weight 1202 g, gestation 30.8 wk) resulted in better growth in preterm VLBW babies as compared to control group (n=81, birth weight 1259 g, gestation 31.3 wk). Weight gain (15.1 and 12.9 g/kg/d, P <0.001), length (1.04 and 0.86 cm/week, P = 0.017) and HC (0.83 and 0.75 cm/week, P<0.001) increased significantly in fortified group. SGA babies showed significant improvements in weight (16 g/Kg/d and 12.9 g/kg/d, P = 0.002) and length (1.09 cm/week and 0.92 cm/week, P = 0.042) in fortified group (n = 38) as compared to control group (n = 29). In AGA subgroup, there was significant increase (P = 0.006) in length (1 cm vs 0.82 cm) in fortified group but no difference in weight (P = 0.12) or HC (P=0.054) in fortified (n=47) vs control (n=52) group. Biochemical parameters were comparable, however feed intolerance was more in control group.


CONCLUSIONS
Preterm VLBW babies showed better growth with human milk fortification. The effect is significant in SGA (weight and length)rather than AGA (only length) babies.
Mukhopadhyay
Kanya
K
Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh 160 012, India. kanyapupul@yahoo.com
Narnag
Anil
A
Mahajan
Rama
R
D005260:Female; D005527:Food, Fortified; D006801:Humans; D041943:Infant Formula; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007236:Infant, Small for Gestational Age / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D008297:Male; D008895:Milk, Human; D015430:Weight Gain