Effect of increasing protein content of human milk fortifier on growth in preterm infants born at <31 wk gestation: a randomized controlled trial.
BACKGROUND
Preterm human milk-fed infants often experience suboptimal growth despite the use of human milk fortifier (HMF). The extra protein supplied in fortifiers may be inadequate to meet dietary protein requirements for preterm infants.


OBJECTIVE
We assessed the effect of human milk fortified with a higher-protein HMF on growth in preterm infants.


METHODS
This is a randomized controlled trial in 92 preterm infants born at <31 wk gestation who received maternal breast milk that was fortified with HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) until discharge or estimated due date, whichever came first. The HMFs used were isocaloric and differed only in the amount of protein or carbohydrate. Length, weight, and head-circumference gains were assessed over the study duration.


RESULTS
Length gains did not differ between the higher- and standard-protein groups (mean difference: 0.06 cm/wk; 95% CI: -0.01, 0.12 cm/wk; P = 0.08). Infants in the higher-protein group achieved a greater weight at study end (mean difference: 220 g; 95% CI: 23, 419 g; P = 0.03). Secondary analyses showed a significant reduction in the proportion of infants who were less than the 10th percentile for length at the study end in the higher-protein group (risk difference: 0.186; 95% CI: 0.370, 0.003; P = 0.047).


CONCLUSIONS
A higher protein intake results in less growth faltering in human milk-fed preterm infants. It is possible that a higher-protein fortifier than used in this study is needed. This trial was registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) as ACTRN12606000525583.
Child Nutrition Research Centre, Women's and Children's Health Research Institute, Flinders Medical Centre, Bedford Park,Australia.
Jacqueline
J
Miller
Maria
M
Makrides
Robert A
RA
Gibson
Andrew J
AJ
McPhee
Tyman E
TE
Stanford
Scott
S
Morris
Philip
P
Ryan
Carmel T
CT
Collins
D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified; D005865:Gestational Age; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D008297:Male; D008894:Milk Proteins / Q000008:administration & dosage*; D008895:Milk, Human; D009751:Nutritional Requirements; D016896:Treatment Outcome; D015430:Weight Gain
D008894:Milk Proteins