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PEDIATRICS Vol. 103 No. 6 June 1999, pp. 1150-1157
Received Sep 18, 1998; accepted Jan 20, 1999.
,
From the * Children's Nutrition Research Center and Sections of
Neonatology and § Pediatric Gastroenterology, Department of
Pediatrics, Baylor College of Medicine, Houston, Texas.
Background. In a large-scale study of feeding strategies in premature infants (early vs later initiation of enteral feeding, continuous vs bolus tube-feeding, and human milk vs formula), the feeding of human milk had more effect on the outcomes measured than any other strategy studied. Therefore, this report describes the growth, nutritional status, feeding tolerance, and health of participating premature infants who were fed fortified human milk (FHM) in comparison with those who were fed exclusively preterm formula (PF).
Methods. Premature infants were assigned randomly in a
balanced two-way design to early (gastrointestinal priming for
10 days) versus late initiation of feeding (total parenteral nutrition
only) and continuous infusion versus intermittent bolus tube-feeding
groups. The type of milk was determined by parental choice and infants to receive their mother's milk were randomized separately from those
to receive formula. The duration of the study spanned the entire
hospitalization of the infant. To evaluate human milk versus formula
feeding, we compared outcomes of infants fed >50
mL · kg
1 · day1 of any human milk
(averaged throughout the hospitalization) with those of infants fed
exclusively PF. Growth, feeding tolerance, and health status were
measured daily. Serum indices of nutritional status were measured
serially, and 72-hour nutrient balance studies were conducted at 6 and
9 weeks postnatally.
Results. A total of 108 infants were fed either >50
mL · kg1 · day1 human milk (FHM,
n = 62) or exclusively PF (n = 46). Gestational age (28 ± 1 weeks each), birth weight (1.07 ± 0.17 vs 1.04 ± 0.19 kg), birth length and head circumference,
and distribution among feeding strategies were similar between groups.
Infants fed FHM were discharged earlier (73 ± 19 vs 88 ± 47 days) despite significantly slower rates of weight gain (22 ± 7 vs 26 ± 6 g · kg1 · day1),
length increment (0.8 ± 0.3 vs 1.0 ± 0.3 cm · week1), and increment in the sum of five skinfold
measurements (0.86 ± 0.40 vs 1.23 ± 0.42 mm · week1) than infants fed PF. The incidence of
necrotizing enterocolitis and late-onset sepsis was less in the FHM
group. Overall, there were no differences in any measure of feeding
tolerance between groups. Milk intakes of infants fed FHM were
significantly greater than those fed PF (180 ± 13 vs 157 ± 10 mL · kg1 · day1). The intakes of
nitrogen and copper were higher and magnesium and zinc were lower in
group FHM versus PF. Fat and energy absorption were lower and
phosphorus, zinc, and copper absorption were higher in group FHM versus
PF. The postnatal retention (balance) surpassed the intrauterine
accretion rate of nitrogen, phosphorus, magnesium, zinc, and copper in
the FHM group, and of nitrogen, magnesium, and copper in the PF group.
Conclusions. Although the study does not allow a comparison of FHM with unfortified human milk, the data suggest that the unique properties of human milk promote an improved host defense and gastrointestinal function compared with the feeding of formula. The benefits of improved health (less sepsis and necrotizing enterocolitis) associated with the feeding of FHM outweighed the slower rate of growth observed, suggesting that the feeding of FHM should be promoted actively in premature infants. Key words: fortified human milk, preterm formula, premature infants, nutritional support.
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