title: Comparison of a Powdered, Acidified Liquid, and Non-Acidified Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants.
abstract: We previously compared infant outcomes between a powdered human milk fortifier (P-HMF) vs. acidified liquid HMF (AL-HMF). A non-acidified liquid HMF (NAL-HMF) is now commercially available. The purpose of this study is to compare growth and outcomes of premature infants receiving P-HMF, AL-HMF or NAL-HMF. An Institutional Review Board (IRB) approved retrospective chart review compared infant outcomes (born < 2000 g) who received one of three HMF. Growth, enteral nutrition, laboratory and demographic data were compared. 120 infants were included (P-HMF = 46, AL-HMF = 23, NAL-HMF = 51). AL-HMF infants grew slower in g/day (median 23.66 vs. P-HMF 31.27, NAL-HMF 31.74 (p < 0.05)) and in g/kg/day, median 10.59 vs. 15.37, 14.03 (p < 0.0001). AL-HMF vs. NAL-HMF infants were smaller at 36 weeks gestational age (median 2046 vs. 2404 g, p < 0.05). However AL-HMF infants received more daily calories (p = 0.21) and protein (p < 0.0001), mean 129 cal/kg, 4.2 g protein/kg vs. P-HMF 117 cal/kg, 3.7 g protein/kg , NAL-HMF 120 cal/kg, 4.0 g protein/kg. AL-HMF infants exhibited lower carbon dioxide levels after day of life 14 and 30 (p < 0.0001, p = 0.0038). Three AL-HMF infants (13%) developed necrotizing enterocolitis (NEC) vs. no infants in the remaining groups (p = 0.0056). A NAL-HMF is the most optimal choice for premature human milk-fed infants in a high acuity neonatal intensive care unit (NICU).
authors.affiliation: Newborn Intensive Care Unit, Nebraska Medicine, 981200 Nebraska Medical Center, Omaha, NE 68198, USA. mthoene@nebraskamed.com.
authors.forename: Melissa
authors.initials: M
authors.lastname: Thoene
authors.affiliation: College of Public Health, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA. elyden@unmc.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lyden
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA. kara.weishaar@unmc.edu.
authors.forename: Kara
authors.initials: K
authors.lastname: Weishaar
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA. elizabeth.elliott@unmc.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Elliott
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA. Ruomei.Wu@Creighton.edu.
authors.forename: Ruomei
authors.initials: R
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA. katelyn.white@huskers.unl.edu.
authors.forename: Katelyn
authors.initials: K
authors.lastname: White
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA. hayley.timm@grmep.com.
authors.forename: Hayley
authors.initials: H
authors.lastname: Timm
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198-1205, USA. alanders@unmc.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: Anderson-Berry
mesh_terms: D000138:Acidosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002657:Child Development; D057286:Electronic Health Records; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005527:Food, Fortified / Q000009:adverse effects; D057141:Food, Preserved / Q000009:adverse effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D041943:Infant Formula / Q000009:adverse effects; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D007363:Intensive Care Units, Neonatal; D008297:Male; D008895:Milk, Human; D009329:Nebraska / Q000453:epidemiology; D047928:Premature Birth / Q000503:physiopathology*; D012189:Retrospective Studies; D012306:Risk
keywords: acidosis; enteral nutrition; fortifier; growth; human milk; necrotizing enterocolitis; premature infant