Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. 766-776 (doi:10.1542/peds.2007-0054)

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ARTICLE

Growth and Nutrient Intakes of Human Milk–Fed Preterm Infants Provided With Extra Energy and Nutrients After Hospital Discharge

Deborah L. O'Connor, PhD, RD^a,b,c, Sobia Khan, MSc, RD^a,b,c, Karen Weishuhn, RD^a,b,c, Jennifer Vaughan, RN, IBCLC^a,c, Ann Jefferies, MD^d,e, Douglas M. Campbell, MD^d,f, Elizabeth Asztalos, MD^d,g, Mark Feldman, MD^d,h, Joanne Rovet, PhD^d, Carol Westall, PhDⁱ, Hilary Whyte, MD^d,j on behalf of the Postdischarge Feeding Study Group

^a Physiology and Experimental Medicine Program
^b Department of Clinical Dietetics
^j Department of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
Departments of ^c Nutritional Sciences
^d Pediatrics
ⁱ Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
^e Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
^f Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada
^g Department of Newborn and Developmental Pediatrics, Sunnybrook Hospital, Toronto, Ontario, Canada
^h Department of Paediatrics, St Joseph's Health Centre, Toronto, Ontario, Canada

OBJECTIVES. The purpose of this pilot study was to determine whether mixing a multinutrient fortifier to approximately one half of the human milk fed each day for a finite period after discharge improves the nutrient intake and growth of predominantly human milk–fed low birth weight infants. We also assessed the impact of this intervention on the exclusivity of human milk feeding.

METHODS. Human milk–fed (80% feeding per day) low birth weight (750–1800 g) infants (n = 39) were randomly assigned at hospital discharge to either a control or an intervention group. Infants in the control group were discharged from the hospital on unfortified human milk. Nutrient enrichment of human milk in the intervention group was achieved by mixing approximately one half of the human milk provided each day with a powdered multinutrient human milk fortifier for 12 weeks after discharge. Milk with added nutrients was estimated to contain 80 kcal (336 kJ) and 2.2 g protein/100 mL plus other nutrients. Intensive lactation support was provided to both groups.

RESULTS. Infants in the intervention group were longer during the study period, and those born 1250 g had larger head circumferences than infants in the control group. There was a trend toward infants in the intervention group to be heavier at the end of the intervention compared with those in the control group. Mean protein, zinc, calcium, phosphorus, and vitamins A and D intakes were higher in the intervention group.

CONCLUSIONS. Results from this study suggest that adding a multinutrient fortifier to approximately one half of the milk provided to predominantly human milk–fed infants for 12 weeks after hospital discharge may be an effective strategy in addressing early discharge nutrient deficits and poor growth without unduly influencing human milk feeding when intensive lactation support is provided.

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Key Words: low birth weight • premature infant • breastfeeding • human milk • growth

Abbreviations: LBW—low birth weight • GTA—greater Toronto area • CA—corrected age • SGA—small for gestational age • SAE—serious adverse event • VLBW—very low birth weight

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Accepted Aug 27, 2007.

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