VLBW: Breast Milk Fortifier Type (2020)

Intervention
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of human milk fortifier type via enteral nutrition on mortality?
- Conclusion
  Limited evidence from one study demonstrated no significant effect (OR, 0.19; 95% CI, 0.01 to 4.08) on mortality in very low birthweight (VLBW) preterm infants that received mother's only milk (MOM) fortified with preterm formula vs standard human milk fortifier (HMF) for two to three 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 fortifier type via enteral nutrition on mortality?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Willeitner A, Anderson M, Lewis J. Highly Concentrated Preterm Formula as an Alternative to Powdered Human Milk Fortifier: A Randomized Controlled Trial. Journal of Pediatric Gastroenterology and Nutrition 2017; 65:574-578
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on blood transfusions and anemia indices?
- Conclusion
  One RCT reported that providing human milk fortifier (HMF) with added iron, protein and essential fatty acids (EFAs) for 28 days significantly decreased odds of blood transfusions (OR, 0.27; 95% CI, 0.11 to 0.65), compared to a standard powdered HMF in very low birthweight (VLBW) preterm infants. There was no effect on hematocrit and ferritin levels.
- Grade: II
  - 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 type of human milk fortifier via enteral nutrition on blood transfusions and anemia indices?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Berseth C, Van Aerde J, Gross S, Stolz S, Harris C, Hansen J. Growth, efficacy, and safety of feeding an iron-fortified human milk fortifier. Pediatrics 2004; 114:e699-706
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on necrotizing enterocolitis or sepsis?
- Conclusion
  Available evidence indicates that the type of human milk fortifier (HMF) (liquid, powder or preterm formula) does not affect incidence of necrotizing enterocolitis (NEC) or sepsis in very low birthweight (VLBW) preterm infants.
- 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 type of human milk fortifier via enteral nutrition on necrotizing enterocolitis or sepsis?
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on weight gain?
- Conclusion
  The evidence suggests that human milk fortifier (HMF) type had no effect on weight gain after two to four weeks of fortification in very low birthweight (VLBW) preterm infants. There was considerable heterogeneity among the studies in terms of which fortifiers they compared, the quality of the studies and the duration of fortifier use.
- 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 type of human milk fortifier via enteral nutrition on weight gain?
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on length gain?
- Conclusion
  The effect of human milk fortifier (HMF) type (powder vs liquid, varying protein or micronutrient amount) on length gain is unclear in very low birthweight (VLBW) preterm infants, due to heterogeneous study interventions and inconsistent results between studies.
- 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 type of human milk fortifier via enteral nutrition on length gain?
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition head circumference gain?
- Conclusion
  The effect of type of human milk fortifier (HMF) via enteral nutrition on head circumference gain was unclear in very low birthweight (VLBW) preterm infants.
- 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 type of human milk fortifier via enteral nutrition head circumference gain?
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on development?
- Conclusion
  No studies were identified that evaluated the effect of type of human milk fortifer (HMF) via enteral nutrition on development.
- 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 Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on gastrointestinal health?
- Conclusion
  One RCT suggests that type of human milk fortifier (HMF) type via enteral nutrition does not affect days until full enteral feeds in very low birthweight (VLBW) preterm infants.
- 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 type of human milk fortifier via enteral nutrition on gastrointestinal health?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Maas C, Mathes M, Bleeker C, Vek J, Bernhard W, Wiechers C, Peter A, Poets C, Franz A. Effect of Increased Enteral Protein Intake on Growth in Human Milk-Fed Preterm Infants: A Randomized Clinical Trial. JAMA Pedatrics 2017; 171:16-22
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on bone mineral content?
- Conclusion
  There is insufficient data to suggest an effect of type of human milk fortifier (HMF) via enteral nutrition on bone mineral content in very low birthweight (VLBW) preterm infants.
- 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 type of human milk fortifier via enteral nutrition on bone mineral content?
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on protein utilization?
- Conclusion
  One RCT suggests that increasing protein and micronutrient levels in human milk fortifier (HMF) for 20 days may result in higher serum BUN levels in very low birthweight (VLBW) preterm infants.
- 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 type of human milk fortifier via enteral nutrition on protein utilization?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Porcelli P, Schanler R, Greer F, Chan G, Gross S, Mehta N, Spear M, Kerner J, Euler A. Growth in human milk-fed very low birth weight infants receiving a new human milk fortifier. Annals of Nutrition and Metabolism 2000; 44:2-10
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of type of human milk fortifier via enteral nutrition on adverse events?
- Conclusion
  Limited evidence suggests that type of human milk fortifier (HMF) (liquid, powdered, macro- or micro-nutrient amount) does not affect risk of adverse events in very low birthweight (VLBW) preterm infants. However, interventions were heterogeneous and no quantitative data was 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 type of human milk fortifier via enteral nutrition on adverse events?
- Search Plan and Results: VLBW: Breast Milk Fortifier Type (2019)