scholarly journals Evaluation of A Concentrated Preterm Formula as a Liquid Human Milk Fortifier in Preterm Babies at Increased Risk of Feed Intolerance

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1433 ◽  
Author(s):  
Anish Pillai ◽  
Susan Albersheim ◽  
Julie Matheson ◽  
Vikki Lalari ◽  
Sylvia Wei ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Clinical Decision ◽  
Feeding Intolerance ◽  
Serious Adverse Events ◽  
Increased Risk ◽  
Preterm Formula ◽  
Feed Intolerance ◽  
Preterm Babies ◽  
Human Milk Fortifier

There are concerns around safety and tolerance of powder human milk fortifiers to optimize nutrition in preterm infants. The purpose of this study was to evaluate the tolerance and safety of a concentrated preterm formula (CPF) as a liquid human milk fortifier (HMF) for premature infants at increased risk of feeding intolerance. We prospectively enrolled preterm infants over an 18-month period, for whom a clinical decision had been made to add CPF to human milk due to concerns regarding tolerance of powder HMF. Data on feed tolerance, anthropometry, and serum biochemistry values were recorded. Serious adverse events, such as mortality, necrotizing enterocolitis (NEC), and sepsis, were monitored. A total of 29 babies received CPF fortified milk during the study period. The most common indication for starting CPF was previous intolerance to powder HMF. Feeding intolerance was noted in 4 infants on CPF. The growth velocity of infants was satisfactory (15.9 g/kg/day) after addition of CPF to feeds. The use of CPF as a fortifier in preterm babies considered at increased risk for feed intolerance seems well tolerated and facilitates adequate growth. Under close nutrition monitoring, this provides an additional option for human milk fortification in this challenging subgroup of preterm babies, especially in settings with limited human milk fortifier options.

scholarly journals Safety of Cow’s Milk-Derived Fortifiers Used with an All-Human Milk Base Diet in Very Low Birthweight Preterm Infants

2020 ◽  
Vol 15 (7) ◽  
pp. 3-13
Author(s):  
Alan Lucas ◽  
Maushumi Assad ◽  
Jan Sherman ◽  
John Boscardin ◽  
Steven Abrams
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Low Birthweight ◽  
Ductus Arteriosus ◽  
Cow’S Milk ◽  
Very Low Birthweight ◽  
Cow's Milk ◽  
Increased Risk ◽  
Preterm Formula ◽  
The Impact

Background: Very low birthweight (VLBW) preterm infants fed mothers own milk (MOM) need nutritional supplementation, traditionally achieved with cow’s milk derived fortifier (CMDF) and preterm formula (PTF) if MOM is insufficient. CM products have been associated with diverse major morbidities. The current recommendation is to preferentially replace PTF with donor milk (DM) to produce a 100% human milk (HM) base diet, usually fortified with CMDF. Objective: To identify whether CMDF, even when fed with a 100% HM base diet, is related to an increased risk of major morbidities. Methods: We identified a randomized trial with an all-HM base diet, comparing CMDF with a fortifier derived from human milk (HMDF), and two additional studies of this design were generated from raw data as subgroup analyses of a randomized controlled trial and a quasi-experimental study. Using these studies, we calculated the impact of CMDF on major morbidities of death, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA). Results: Each study individually provided support for an increase in major morbidities with CMDF. Meta-analyses of pooled data showed that compared to HMDF, the CMDF group had large in- creases in NEC (RR = 3.3; P = .001), ROP (RR = 2.2; P = .007), PDA (RR = 1.6; P = .009), interruption of feeding (RR = 3.4; P = .001) and a positive mortality/morbidity index based on one or more of death, NEC, sepsis, ROP and BPD (RR = 1.4; P = .006). Conclusions: Despite the increased use of HM in modern neonatal care as a base diet, we found a greater risk of critical morbidities with CMDF compared with HMDF. This burden of morbidity provides evidence that the benefits of an HM base diet, might be, in part, counteracted by multiple adverse outcomes relating to the use of CMDF.

scholarly journals Effects on Gastroesophageal Reflux of Donkey Milk-Derived Human Milk Fortifier Versus Standard Fortifier in Preterm Newborns: Additional Data from the FortiLat Study

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2142 ◽  
Author(s):  
Francesco Cresi ◽  
Elena Maggiora ◽  
Alice Pirra ◽  
Paola Tonetto ◽  
Carlotta Rubino ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gastric Emptying ◽  
Gastroesophageal Reflux ◽  
Human Milk ◽  
Preterm Infants ◽  
Feeding Intolerance ◽  
Donkey Milk ◽  
Gastric Emptying Time ◽  
Human Milk Fortifier ◽  
Emptying Time

Background: Feeding intolerance is a frequent diagnosis in very preterm infants. As seen in the FortiLat trial, human milk fortification with the new donkey milk-derived human milk fortifier (DF) seems to improve feeding tolerance in these infants. The aim of this study was to evaluate the effects of using the DF compared with bovine milk-derived fortifier (BF) on gastroesophageal reflux (GER) in very low birth weight (VLBW) infants. Methods: Over a total of 156 preterm infants were enrolled into the FortiLat trial (GA <32 weeks and birth weight <1500 g) and randomized into the BF arm or DF arm, and we selected all infants with clinical signs of GER and cardiorespiratory (CR) symptoms. All the infants underwent CR and multichannel intraluminal impedance and pH (MII/pH) monitoring associated with gastric ultrasound to evaluate GER and gastric emptying time. Results: 10 infants were enrolled, and 5 were in the DF arm. At MII/pH, infants enrolled into the DF arm showed a lower GER frequency than BF arm infants (p = 0.036). Half gastric emptying time was similar in DF and BF arm infants (p = 0.744). Conclusion: The use of donkey-derived human milk fortifier reduced the GER frequency and consequently should be recommended in infants with feeding intolerance.

scholarly journals Allergen Shedding in Human Milk from Mothers of Preterm Infants: Proteomic and Peptidomic Feasibility and Pilot Analysis

2021 ◽  
Author(s):  
Kathleen Luskin ◽  
Diba Mortazavi ◽  
Sherry Bai-Tong ◽  
Kerri Bertrand ◽  
Christina Chambers ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Human Milk ◽  
Preterm Infants ◽  
Protease Activity ◽  
Protein Detection ◽  
Milk Samples ◽  
Preterm Formula ◽  
Two Samples ◽  
Human Proteins ◽  
Human Milk Fortifier

Abstract Rationale: There is little information regarding the allergen content of milk feeds in the preterm population. Previous studies have evaluated specific proteins/peptides via ELISA, but no studies have performed a broad analysis of the allergenic peptide content and protease activity of milk feeds in this population. Preterm infants spend a critical window of time for immune development in the Newborn Intensive Care Unit (NICU), and may receive fortified donor milk, maternal milk or formula feeds via nasogastric tube or bottle instead of fresh breastmilk via breastfeeding. Methods: To evaluate feasibility, we initially performed mass spectrometry on four human milk samples (two term and two preterm) from the Mommy’s Milk Human Milk Biorepository (HMB) which included maternal surveys of diet and environmental exposures. We analyzed the results against the University of Nebraska FASTA database and UniProt for a total of 2211 protein sequences. We then further analyzed 5 samples from the Microbiome, Atopy and Prematurity (MAP) pilot study along with formula and human milk fortifier controls and performed not only mass spectrometry, but also peptidomic and protease activity analysis. Results: Each HMB sample had between 806 and 1007 proteins, with 37 to 44 non-human proteins/sample encompassing 26 plant and animal species. Bovine proteins were the most numerous; seven unique Bos taurus proteins were found in all four samples, and three contained Bos d 5. Cat, dog, mosquito, salmon, and crab were detected in all four samples. All donors ingested fish, shellfish and tree nuts, and all had salmon and crab proteins in their milk samples; two almond proteins were detected in three samples. Aeroallergens, including dust mite (Der f 28, Der f 25) and mold (Cla h 4) were identified in all samples. Two samples contained allergens to latex (Hev b 9) and chicken (Gal d 10). One sample contained several unique proteins, including carrot, two molds (including Pen c 19) and Der f 33-like protein. In the preterm MAP samples, 784 digested non-human proteins were identified, 30 were non-bovine in origin. Proteins from 23 different species including aeroallergens, food, and contact allergens were identified. Protease activity was highest in human milk samples without human milk fortifier and lowest in preterm formula. Conclusions: These findings represent the first preterm milk feed mass spectrometry and protease analysis with identification of known allergenic proteins to food, contact and aeroallergens. The varying degree of protein detection may reflect variable individual secretion and augmentation of feeds. This raises questions of whether the composition of milk feeds in the NICU impact the development of atopic disease in the preterm population and whether the complex interaction between allergens, proteases, and other human milk components can serve to induce sensitization or tolerance to allergens in infants.

scholarly journals A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2089
Author(s):  
Machiko Suganuma ◽  
Alice R. Rumbold ◽  
Jacqueline Miller ◽  
Yan Fong Chong ◽  
Carmel T. Collins
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Meta Analysis ◽  
Poor Quality ◽  
Low Birth Weight Infants ◽  
Preterm Formula ◽  
Meta Analyses

Human milk (HM) is the gold standard for feeding infants but has been associated with slower growth in preterm infants compared with preterm formula. This systematic review and meta-analysis summarises the post-1990 literature to examine the effect of HM feeding on growth during the neonatal admission of preterm infants with birth weight ≤1500 g and/or born ≤28 weeks’ gestation. Medline, PubMed, CINAHL, and Scopus were searched, and comparisons were grouped as exclusive human milk (EHM) vs. exclusive preterm formula (EPTF), any HM vs. EPTF, and higher vs. lower doses of HM. We selected studies that used fortified HM and compared that with a PTF; studies comparing unfortified HM and term formula were excluded. Experimental and observational studies were pooled separately. The GRADE system was used to evaluate risk of bias and certainty of evidence. Forty-four studies were included with 37 (n = 9963 infants) included in the meta-analyses. In general, due to poor quality studies, evidence of the effect of any HM feeds or higher versus lower doses of HM was inconclusive. There was a possible effect that lower doses of HM compared with higher doses of HM improved weight gain during the hospital admission, and separately, a possible effect of increased head circumference growth in infants fed EPTF vs. any HM. The clinical significance of this is unclear. There was insufficient evidence to determine the effects of an exclusive HM diet on any outcomes.

A New Liquid Human Milk Fortifier and Linear Growth in Preterm Infants

PEDIATRICS ◽  
2012 ◽  
Vol 130 (4) ◽  
pp. e928-e935 ◽  
Author(s):  
F. Moya ◽  
P. M. Sisk ◽  
K. R. Walsh ◽  
C. L. Berseth
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Linear Growth ◽  
Human Milk Fortifier

scholarly journals Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial

2018 ◽  
Vol 44 (1) ◽  
Author(s):  
Simonetta Costa ◽  
Luca Maggio ◽  
Giovanni Alighieri ◽  
Giovanni Barone ◽  
Francesco Cota ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula

scholarly journals Hypertensive Disorders during Pregnancy and Risk of Bronchopulmonary Dysplasia in Very Preterm Infants

2018 ◽  
Vol 36 (02) ◽  
pp. 176-183
Author(s):  
Filipa de Lima ◽  
Ana Machado ◽  
Hercília Guimarães ◽  
Gustavo Rocha ◽  
Keyword(s):  
Arterial Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Hypertension ◽  
Newborn Infants ◽  
Chronic Hypertension ◽  
Very Preterm Infants ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
Preterm Babies

Introduction It is not yet fully known whether hypertensive disorders (HTD) during pregnancy impose an increased risk of development of bronchopulmonary dysplasia (BPD) in preterm newborn infants. Objective To test the hypothesis that preeclampsia and other HTD are associated with the development of BPD in preterm infants. Materials and Methods Data on mothers and preterm infants with gestational age 24 to 30 weeks were prospectively analyzed in 11 Portuguese level III centers. Statistical analysis was performed using IBM SPSS statistics 23. Results A total of 494 preterm infants from 410 mothers were enrolled, and 119 (28%) of the 425 babies, still alive at 36 weeks, developed BPD. The association between chronic arterial hypertension, chronic arterial hypertension with superimposed preeclampsia, and gestational hypertension in mothers and BPD in preterm infants was not significant (p = 0.115; p = 0.248; p = 0.060, respectively). The association between preeclampsia–eclampsia and BPD was significant (p = 0.007). The multivariate analysis revealed an association between preeclampsia–eclampsia and BPD (odds ratio [OR] = 4.6; 95% confidence interval [CI] 1.529–13.819; p = 0.007) and a protective effect for BPD when preeclampsia occurred superimposed on chronic arterial hypertension in mothers (OR = 0.077; 95%CI 0.009–0.632; p = 0.017). Conclusion The results of this study support the association of preeclampsia in mothers with BPD in preterm babies and suggest that chronic hypertension may be protective for preterm babies.

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