title: Association of metabolic acidosis with bovine milk-based human milk fortifiers.
abstract: OBJECTIVE
  To compare the incidence of metabolic acidosis and feeding intolerance associated with powdered or acidified liquid human milk fortifier (HMF).
  
  
  METHODS
  This retrospective study evaluated infants ⩽ 32 weeks gestational age or ⩽ 1500 g birth weight who received human milk with either powdered or acidified liquid HMF (50 consecutively born infants per group). Primary outcomes tracked were metabolic acidosis (base excess less than -4 mmol l(-1) or bicarbonate less than 18 mmol l(-1)), feeding intolerance (gastric residual > 50% feed volume, > 3 loose stools or emesis per day, abdominal tenderness or distention), necrotizing enterocolitis, late-onset infection, death, length of hospital stay and ability to remain on HMF. Demographics, feeding practices, growth parameters and laboratory data were also collected.
  
  
  RESULTS
  Significantly more infants who received acidified liquid HMF developed metabolic acidosis (P < 0.001). Base excess and bicarbonate were both significantly decreased after HMF addition in the liquid HMF group (base excess P = 0.006, bicarbonate P < 0.001). More infants were switched off liquid HMF due to metabolic acidosis or feeding intolerance than those on powdered HMF (P < 0.001). Despite increased protein intake in the liquid HMF group (P = 0.009), both groups had similar enteral caloric intakes with no difference in growth rates between the two groups. There was no significant difference in any of the other primary outcomes.
  
  
  CONCLUSIONS
  Infants receiving acidified liquid human milk fortifier were more likely to develop metabolic acidosis and to be switched off HMF than those who received powdered HMF. Growth in the liquid HMF group was no different than the powdered group, despite higher protein intake.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University, St Louis, MO, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Cibulskis
authors.affiliation: Saint Louis University Center for Outcomes Research, Saint Louis University, St Louis, MO, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Armbrecht
mesh_terms: D000138:Acidosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D000818:Animals; D004044:Dietary Proteins / Q000009:adverse effects / Q000378:metabolism; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified / Q000009:adverse effects*; D006801:Humans; D007228:Infant Nutrition Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007230:Infant, Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology; D007902:Length of Stay; D008297:Male; D008892:Milk / Q000009:adverse effects / Q000592:standards; D008895:Milk, Human; D017063:Outcome Assessment, Health Care; D011208:Powders; D012189:Retrospective Studies
chemical_list: D004044:Dietary Proteins; D011208:Powders
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