Growth and Clinical Outcomes of Very Low‐Birth‐Weight Infants Receiving Acidified vs Nonacidified Liquid Human Milk Fortifiers. (25th August 2020)

• Record Type: Journal Article
• Authors: Cordova, Erika G.; Soldateli, Betina; Rosner, Bernard; Drouin, Kaitlin; Davitt, Emma; Pepin, Hunter L.; Ellard, Deirdre M.; Yu, Angela; Bell, Katherine; Belfort, Mandy Brown
• Is Part Of: Nutrition in clinical practice. Volume 36:Number 6(2021)
• Page Start: 1304
• Page End: 1311
• Publication Date: 2020-08-25
• Subjects: growth -- head circumference -- human milk fortifier -- length -- metabolic acidosis -- very low birth weight infant -- weight; Nutrition -- Periodicals; Diet therapy -- Periodicals; Artificial feeding -- Periodicals; 615.854
• DOI: 10.1002/ncp.10569
• Languages: English
• ISSNs: 0884-5336

Abstract

Abstract: Background: Liquid human milk fortifiers are used commonly in neonatal intensive care. Use of an acidified HMF (A‐HMF) is associated with transient metabolic acidosis, but whether growth outcomes differ between infants fed A‐HMF vs nonacidified HMF (NA‐HMF) remains unknown. Methods: Retrospective cohort study of 255 infants born at <33 weeks' gestation and ≤1500 g who were receiving ≥75% fortified human milk on day of life 14, in a level III neonatal intensive care unit (NICU) from May 2015 to December 2018. Infants born before October 2017 (n = 165) received A‐HMF, whereas infants born after October 2017 (n = 90) received NA‐HMF. We used logistic regression to estimate odds of metabolic acidosis (serum bicarbonate <16 mEq/L in the first 21 days of life) in infants receiving A‐HMF vs NA‐HMF and linear mixed models to compare the mean size at discharge (weight, length, head z ‐scores) by HMF type. We adjusted models for confounders and accounted for the nonindependence of multiple births. Results: Median gestational age was 28.7 weeks (range, 22.6–32.9) and birth weight 1.1 kg (range, 0.4–1.5). Infants receiving A‐HMF had higher adjusted odds of metabolic acidosis than infants receiving NA–HMF (adjusted odds ratio, 2.7; 95% CI, 1.2–6.2). There were no differences between groups in size z ‐scores at discharge. Conclusions: In human‐milkfed, very‐low‐birthweight infants, fortification with liquid A‐HMF may contribute to metabolic acidosis in the first month of life, but this practice does not appear to impair growth through NICU discharge, compared with fortification with NA‐HMF.