Growth Changes in Premature Neonates: A Retrospective
Analysis of Human versus Bovine Milk Fortifiers
Investigator
Kelsie Ophus, PharmD, PGY1 Pharmacy Resident
Billings Clinic, 2800 10th Ave N, Billings, MT 59101
[email protected]
Background
 The American Academy of Pediatrics recommends the use of human milk products in all infants, especially those
1
born prior to 37 weeks completed gestation.
 Premature infants are at high risk for slow growth, metabolic abnormalities, and poor neurodevelopmental
outcomes, especially when not provided with adequate nutrition and will lose approximately 15-20% of their body
weight after birth.
 Human liquid milk fortifiers vary in macronutrient content, specifically protein content, when compared to bovine
liquid milk fortifiers.
 Previous studies have shown decreased incidence of necrotizing enterocolitis, decrease in days to reach full
2,3
feeds, fewer TPN days, and earlier fortification of feeds sooner with human milk fortifier compared to bovine.
Methods
Objective: determine if human liquid milk fortifiers result in better quality growth in hospitalized premature neonates when
compared to bovine liquid milk fortifier as measured by z-scores
 Retrospective, single-center, chart review
 Study groups: bovine vs human liquid milk fortifier groups - subgroups based on gestational age (27-29 weeks
and 30-32 weeks)
Inclusion Criteria
 Newborn infants born at <37 weeks gestation
 Hospitalized in the NICU within the first 48 hours after
birth
 Birth weight <2000 grams
 Received human or bovine milk fortifier
supplementation in full enteral feeds for ≥3 weeks
 Milk fortified to ≥24 kcal/kg/day on day 1 of full enteral
feedings
 Weight, height, and head circumference measurements
completed at birth and on days 1, 7, 14, and 21 of full
enteral feeds
Exclusion Criteria
 Expired or transferred before completion of 3 weeks
of milk fortifier regimen
 Gestational age >34 weeks at day 1 of start of full
enteral feedings with milk fortifier
 Congenital defects
 Patent ductus arteriosus
 Inborn errors of metabolism
Primary Outcome
 Analyze the change in weight-for-age z-scores and height-for-age z-score after 3 weeks in hospitalized premature
neonates receiving human milk fortifier or bovine milk fortifier with full enteral feeds
Secondary Outcomes
 Total kilocalories per kilogram per day (kcal/kg/day) from all sources on day one of full enteral feeds
 Number of days until the subject reached full enteral feeds
 Average weekly total calorie load before the start of full enteral feeds
 Change in head circumference-for-age z-scores
Results - Baseline Characteristics
Weight
Height
Head Circumference
Height Z-Score Difference from Birth to Day 21
Height Difference
Weight Difference
Primary Outcome
Weight Z-Score Difference from Birth to Day 21
Head Circumference
Difference
Secondary Outcomes
Head Circumference Z-Score Difference from Birth to Day 21
Gestational
Age (weeks)
Discussion
 No difference observed between human and bovine liquid milk fortifiers in weight, height, or head circumference
 While providing more kcal/kg/day in the human liquid milk fortifier, no significant difference was observed in
quality growth as illustrated by z-scores
 Comparable growth rates to previous studies
Limitations
 Retrospective design (potential for charting errors and anthropometric measurements not standardized)
 Large exclusion population
 Only analyzed for 3 week time period
 Underpowered for subgroup analysis
 Change in gestational age/size of babies admitted to NICU when human liquid milk fortifier added to formulary
Conclusions
 In this study, subjects in the human liquid milk fortifier group received higher kilocalories per kilograms per day but
did NOT have any significant difference in the quality growth outcomes
References:
1.
2.
3.
American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-41.
Hair A, Hawthorne K, Chetta K, et al. Human milk feeding supports adequate growth in infants ≤ 1250 grams birth weight. BMC Res Notes. 2013;6:459-66.
Sullivan S, Schanler R, Kim J, et al. An exclusively human milk-based diet is associated with lower rate of necrotizing enterocolitis than a diet of human milk and
bovine milk-based products. J Pediatr. 2010;156:562-67.