Expressed breast milk (EBM) Fortification using commercially available human milk fortifiers (HMF) can increase short-term weight and length in preterm very-low-birth-weight (VLBW) neonates. However, they are costly and possess an increased risk of feed intolerance thus limiting their widespread use. Preterm formula powder fortification (PTF) might be a more suitable alternative in resource-limited settings.

A recent study demonstrated that fortification of EBM by preterm formula powder is non-inferior to fortification by HMF, regarding short-term weight gain, in VLBW neonates.

Preterm (born at or before 34 weeks of gestation) VLBW neonates who received at least 100 mL/kg/d of feeds and consumed 75% of milk or more as EBM was selected for the study.

Neonates were randomized to receive fortification by either PTF or HMF. Calcium, phosphorus, iron, vitamin D, and multivitamins in PTF, while only vitamin D in the HMF group were supplemented.

The weight gain until discharge from the hospital or 40 weeks’ postmenstrual age, whichever was earlier; the prespecified noninferiority margin was 2 g/kg/d, was assessed. Morbidities such as necrotizing enterocolitis, feed intolerance, and extrauterine growth restriction were also evaluated.

The results were as follows-

• 123 neonates were enrolled, of which 60 and 63 were randomized to the PTF and HMF groups, respectively.
• Both groups had comparable mean gestation (30.5 vs 29.9 weeks) and birth weight (1161 vs 1119 g).
• No difference in the mean (SD) weight gain between the PTF and HMF groups (15.7 [3.9] vs 16.3 [4.0] g/kg/d) was observed.
• The lower bound of 95% CI did not traverse the noninferiority margin.
• PTF group showed a lower incidence of feed intolerance, and fewer neonates demanded withholding of fortification for 24 hours or more.
• Both the group showed a comparable incidence of necrotizing enterocolitis stage II or more and extrauterine growth restriction.

Thus, Fortification with preterm formula powder is not inferior to fortification with human milk fortifiers in preterm neonates. Due to lesser feed intolerance and costs, the preterm formula might be a better option for fortification, especially in resource-restricted settings.

Source: Chinnappan A, Sharma A, Agarwal R, Thukral A, Deorari A, Sankar MJ. Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial. JAMA Pediatr. 2021;175(8):790–796. doi:10.1001/jamapediatrics.2021.0678