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Developmental Biology - Premature Infant Health

"Preemies" Need Breast Millk

Underweight premature babies do better - without side effects - on formula fortified with human milk...


New research from the University of Missouri (MU) and University College London, suggests using human-based milk fortifiers as they produce better health outcomes in severely underweight, premature babies when compared to health/weight results with traditional, cow-based milk fortifiers.
More than 380,000 babies are born prematurely in the United States every year according to the March of Dimes.

"Preemies" who are severely underweight need easily digestible feedings full of nutrients.

Neonatal intensive care units add milk fortifiers to supplement the cow or donor breast milk given to preemies to promote weight gain and benefit their continued development.

To analyze which of two fortifiers produced the best results in these fragile patients, Jan Sherman PhD, and Alan Lucas MD, conducted a meta-analysis of 450 current studies on severely underweight, preemies. The data came from the United States, Canada and Austria. Premature infants hsd received either traditional (1) cow-based milk fortifiers or (2) human-based fortifiers.
Comparing infant health outcomes, researchers found babies fed cow milk fortifiers were more than three times as likely to develop necrotizing enterocolitis, a life-threatening intestinal disease. Cow milk fortified infants were also more than twice as likely to develop retinopathy of prematurity, an eye disorder that can lead to blindness.

Neonatal intensive care units can now use this research to re-evaluate the nutritional supplements they add to fortify the feedings of "preemies".
"Everyone wants what's best for these underweight, premature babies, and choosing the best type of milk fortifiers for feeding can help lead to improved health outcomes. Nearly half of neonatal intensive care units in the United States, including the one at MU Children's Hospital, are already using human-based milk fortifiers. If we can reduce these cases of necrotizing enterocolitis, if we can preserve their eye sight and reduce the risk of infection, that will benefit the babies' health in the long term."

Jan Sherman-Lucas, PhD, RN, NNP-BC, Adjunct Teaching Professor, Department of Child Health, School of Medicine, University of Missouri, Columbia, Missouri, USA.
"Our research is geared toward understanding if we can avoid cow's milk fortifiers while still feeding premature infants well. The most current evidence suggests that a diet with entirely human milk and enriched feeds manufactured from donated human milk will meet the nutritional needs of the baby without the potential negative health effects that can come with a cow milk fortifier."

Alan Lucas, MD, FRCP, FRCPCH. Emeritus Professor - Child Nutrition Research Centre, Institute of Child Health, University College London, London, England.

This research is published in Neonatology Today.

Abstract/Background
Very low birthweight (VLBW) preterm infants fed mothers own milk (MOM) need nutritional supplementation, traditionally achieved with cow's milk (CM) derived fortifier CMDF) and preterm formula (PTF) if MOM is insufficient. CM products have been associated with diverse major morbidities. The current recommendation is to preferentially replace PTF with donor milk (DM) to produce a 100% human milk (HM) base diet, usually fortified with CMDF.

Objective
To identify whether CMDF, even when fed with a 100% HM base diet, is related to an increased risk of major morbidities.

Methods
We identified a randomized trial with an all-HM base diet, comparing CMDF with a fortifier derived from human milk (HMDF), and two additional studies of this design were generated from raw data as subgroup analyses of a randomized controlled trial and a quasi-experimental study. Using these studies, we calculated the impact of CMDF on major morbidities of death, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA).

Results
Each study individually provided support for an increase in major morbidities with CMDF. Meta-analyses of pooled data showed that compared to HMDF, the CMDF group had large increases in NEC (RR=3.3; P=0.001), ROP (RR=2.2; P=0.007), PDA (RR=1.6; P=0.009), interruption of feeding (RR=3.4;P=0.001) and a positive mortality/morbidity index based on one or more of death, NEC, sepsis, ROP and BPD (RR=1.4; P=0.006).

Conclusions
Despite the increased use of HM in modern neonatal care as a base diet, we found a greater risk of critical morbidities with CMDF compared with HMDF. This burden of morbidity provides evidence that the benefits of an HM base diet, might be, in part, counteracted by multiple adverse outcomes relating to the use of CMDF.

Authors
Alan Lucas MD FMedSci, Maushumi Assad MD, MPH, Jan Sherman PhD, John Boscardin PhD, Steven Abrams MD. Other authors: Maushumi Assad of the Beth Israel Deaconess Medical Center, John Boscardin of UC San Francisco and Steven Abrams of University of Texas, Austin.

Acknowledgements

Financial support
None

Conflicts of Interest
Dr. Lucas has provided independent scientific advice to Philips, Prolacta, and Nestle.; Dr. Assad, none; Dr. Sherman, none; Dr. Boscardin, none. Dr. Abrams, none.

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Aug 24 2020   Fetal Timeline   Maternal Timeline   News



New meta-analysis of milk fortifiers fed to severly underweight "preemies" supports avoiding
fortifiers made from cow's milk. CREDIT Image In The Public Domain.



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