Targeted individualized versus standardized preterm human breast milk fortification: A randomized controlled trial

Abstract

Introduction: Extrauterine growth retardation (EUGR) is one of the major problems faced in most preterm neonates. The only way to prevent EUGR is by providing adequate amount of calories through fortification of human breast milk. Human milk fortification (HMF) is now considered a standard practice to prevent EUGR in most of the neonatal units. We compared targeted individualized fortification (TIF) versus standardized fortification (SF) of breast milk with HMF to assess catch-up growth in preterm neonates. Materials and Methods: We conducted a prospective randomized control study at a tertiary neonatal intensive care unit in urban India for 1 year. Appropriate for gestational age neonates ≤32 weeks of gestation or with birth weight ≤1800 g were enrolled and followed up for 50 corrected weeks for the assessment of catch-up growth. Results: A total of 32 infants were enrolled; 25 neonates completed the study (TIF: n = 13; SF: n = 12). The mean birth weight and head circumference were 1268.76 g and 27.23 cm in the TIF group and 1172.83 g and 26.58 cm in the SF group, respectively (both P > 0.05). At the end of the study, catch-up growth for weight was achieved by 10 (77%) neonates in the TIF group and 2 (17%) neonates in the SF groups. Similarly, catch-up growth for head circumference was achieved by 7 (54%) and 1 (8%) neonates in the TIF and SF groups, respectively. However, there was a significant difference in weight (P = 0.00071) and head circumference (P = 0.001752) in the TIF group at the end of the study. Conclusion: TIF is feasible in clinical practice. In preterm neonates, it helps in achieving catch-up growth faster and may decrease the rates of EUGR.