Early full enteral nutrition with fortified milk in very preterm infants: a randomized clinical trial.

IF 6.5 1区医学 Q1 NUTRITION & DIETETICS American Journal of Clinical Nutrition Pub Date : 2025-02-20 DOI:10.1016/j.ajcnut.2025.02.019

Ariel A Salas, Emily Gunawan, Seabrook Jeffcoat, Kelly Nguyen

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Abstract

Background: In preterm infants, the timing of human milk fortification when maternal or donor milk is offered at volumes of 60-80 ml/kg/day within the first 36 hours after birth remains a matter of debate.

Objective: This trial assessed the impact of early human milk fortification (< 7 days postnatal age) on fat-free mass (FFM) z-scores.

Methods: This was an unmasked clinical trial involving preterm infants with birthweight < 1800 g and gestational ages ranging from 29 0/7 to 33 6/7 weeks gestation. Human milk-fed infants receiving feeding volumes of 60-80 ml/kg/day within the first 36 hours after birth were randomized to receive either early (between day 4 and 7) or delayed (between day 10 and 14) fortification using a bovine-derived fortifier. FFM was assessed at postnatal day 21 using air-displacement plethysmography.

Results: A total of 80 infants were randomized. The mean birthweight was 1488 g (SD: 233). Baseline characteristics did not differ between groups. Of 80 infants randomized shortly after birth, 74 had the primary outcome measured at approximately 35 weeks of postmenstrual age (IQR: 34 - 36). No statistically significant differences in FFM z-scores were observed between the two groups (-1.7 ± 0.9 compared with -1.8 ± 0.9; p=0.64), but the early fortification group had higher weight (median difference: +131 g; 95% CI: 12, 236; p=0.03), higher FFM (median difference: +103 g; 95% CI: 1, 193; p=0.03), and higher length (mean difference: +0.9 cm; 95% CI: 0.1, 1.8; p=0.04) at the time of body composition assessment.

Conclusion: In very preterm infants receiving early full enteral nutrition, providing early human milk fortification does not result in higher than usual FFM z-scores. This feeding strategy may, however, lead to a sustained increase in length, and transient increases in weight and FFM in grams.

Clinical trial registration: ClinicalTrials.gov: NCT05525585; https://clinicaltrials.gov/study/NCT05525585.

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来源期刊

American Journal of Clinical Nutrition 医学-营养学

CiteScore

12.40

自引率

4.20%

发文量

332

审稿时长

38 days

期刊介绍： American Journal of Clinical Nutrition is recognized as the most highly rated peer-reviewed, primary research journal in nutrition and dietetics.It focuses on publishing the latest research on various topics in nutrition, including but not limited to obesity, vitamins and minerals, nutrition and disease, and energy metabolism. Purpose: The purpose of AJCN is to: Publish original research studies relevant to human and clinical nutrition. Consider well-controlled clinical studies describing scientific mechanisms, efficacy, and safety of dietary interventions in the context of disease prevention or health benefits. Encourage public health and epidemiologic studies relevant to human nutrition. Promote innovative investigations of nutritional questions employing epigenetic, genomic, proteomic, and metabolomic approaches. Include solicited editorials, book reviews, solicited or unsolicited review articles, invited controversy position papers, and letters to the Editor related to prior AJCN articles. Peer Review Process: All submitted material with scientific content undergoes peer review by the Editors or their designees before acceptance for publication.