Preterm Infant (VLBW) Enteral Nutrition

VLBW: Breast Milk Fortifiers (2020)

• Intervention
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on morbidities and mortality?

  • Conclusion

    No studies were identified that evaluated the effect of human milk fortification vs. none via enteral nutrition on morbidities and mortality.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on weight gain?

  • Conclusion

    In three small RCTs, very low birthweight (VLBW) preterm infants in the newborn intensive care unit (NICU) receiving multi-nutrient fortification for two to four weeks demonstrated increased weight gain (SMD, 1.0; 95% CI, 0.16 to 1.8), compared to human milk alone. This effect size may have been moderated and confounded by source of human milk, the only study that used both mother's own milk (MOM) and donor milk did find an effect of fortification on weight gain.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on weight gain?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Carey D, Rowe J, Goetz C, Horak E, Clark R, Goldberg B. Growth and phosphorus metabolism in premature infants fed human milk, fortified human milk, or special premature formula. Use of serum procollagen as a marker of growth. American Journal of Diseases of Children 1987; 141:511-5
      • Modanlou H, Lim M, Hansen J, Sickles V. Growth, biochemical status, and mineral metabolism in very-low-birth-weight infants receiving fortified preterm human milk. Journal of Pediatric Gastroenterology and Nutrition 1986; 5:762-7
      • Nicholl R, Gamsu H. Changes in growth and metabolism in very low birthweight infants fed with fortified breast milk. Acta Paediatrica 1999; 88:1056-61
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on weight gain post discharge?

  • Conclusion

    One small RCT found no effect on weight gain in very low brithweight (VLBW) preterm infants post-discharge when human milk was fortified with multi-nutrient fortification, compared to human milk alone for 12 weeks, though numeric data was not provided.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on weight gain post discharge?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • O'Cnnor D, Khan S, Weishuhn K, Vaughan J, Jefferies A, Campbell D, Asztalos E, Feldman M, Rovet J, Westall C, Whyte H. Growth and nutrient intakes of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge. Pediatrics 2008; 121:766-76
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on length gain?

  • Conclusion

    Length gain was not significantly increased (SMD, 0.5cm per week; 95% CI, -0.2 to 1.1) in very low birthweight (VLBW) preterm infants in the newborn intensive care unit (NICU) when human milk was fortified with multi-nutrient fortification, compared to human milk alone, for two to four weeks.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on length gain?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Modanlou H, Lim M, Hansen J, Sickles V. Growth, biochemical status, and mineral metabolism in very-low-birth-weight infants receiving fortified preterm human milk. Journal of Pediatric Gastroenterology and Nutrition 1986; 5:762-7
      • Nicholl R, Gamsu H. Changes in growth and metabolism in very low birthweight infants fed with fortified breast milk. Acta Paediatrica 1999; 88:1056-61
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on length gain post discharge?

  • Conclusion

    One small RCT suggested a beneficial effect on length gain in very low brithweight (VLBW) preterm infants post-discharge when human milk was fortified with multi-nutrient fortification, compared to human milk alone after 12 weeks, but no numerical results were provided.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on length gain post discharge?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • O'Cnnor D, Khan S, Weishuhn K, Vaughan J, Jefferies A, Campbell D, Asztalos E, Feldman M, Rovet J, Westall C, Whyte H. Growth and nutrient intakes of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge. Pediatrics 2008; 121:766-76
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on head circumference?

  • Conclusion

    A significant effect on head circumference gain (MD, 0.33cm per week; 95% CI, 0.13 to 0.52) was found in very low brithweight (VLBW) preterm infants in the newborn intensive care unit (NICU) when human milk was fortified with multi-nutrient fortification, compared to human milk alone for four to five weeks.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on head circumference?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Carey D, Rowe J, Goetz C, Horak E, Clark R, Goldberg B. Growth and phosphorus metabolism in premature infants fed human milk, fortified human milk, or special premature formula. Use of serum procollagen as a marker of growth. American Journal of Diseases of Children 1987; 141:511-5
      • Modanlou H, Lim M, Hansen J, Sickles V. Growth, biochemical status, and mineral metabolism in very-low-birth-weight infants receiving fortified preterm human milk. Journal of Pediatric Gastroenterology and Nutrition 1986; 5:762-7
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on head circumference post discharge?

  • Conclusion

    One small study found a significant effect on head circumference gain (MD, 1.10cm; 95% CI, 0.76 to 1.44) in very low brithweight (VLBW) preterm infants post-discharge when mother's own milk (MOM) was fortified with multi-nutrient fortification, compared to MOM alone for 12 weeks.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on head circumference post discharge?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Aimone A, Rovet J, Ward W, Jefferies A, Campbell D, Asztalos E, Feldman M, Vaughan J, Westall C, Whyte H, O'Connor D. Growth and body composition of human milk-fed premature infants provided with extra energy and nutrients early after hospital discharge: 1-year follow-up. Journal of Pediatric Gastroenterology and Nutrition 2009; 49:456-66
      • O'Cnnor D, Khan S, Weishuhn K, Vaughan J, Jefferies A, Campbell D, Asztalos E, Feldman M, Rovet J, Westall C, Whyte H. Growth and nutrient intakes of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge. Pediatrics 2008; 121:766-76
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortification vs. none via enteral nutrition on development, gastrointestinal health, bone mineral content, protein utilization or adverse events?

  • Conclusion

    No studies were identified that evaluated the effect of human milk fortification vs. none, via enteral nutrition on development, gastrointestinal health, bone mineral content, protein utilization or adverse events.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: VLBW: Breast Milk Fortifiers (2019)