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Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study

DOI: 10.1186/1471-2431-12-124

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Retrospective cohort study.171 infants with median gestational age 27 weeks (IQR 25.4, 28.9) and median birthweight 899 g (IQR 724, 1064) were included. 97% of infants received human milk, 51% received > 75% of all enteral intake as human milk. 16% of infants were small-for-gestational age (SGA, < 10th percentile) at birth, and 34% of infants were SGA at discharge. Infants fed >75% human milk had a greater negative change in weight z-score from birth to discharge compared to infants receiving < 75% (?0.6 vs, -0.4, p = 0.03). Protein and caloric supplementation beyond standard human milk fortifier was related to human milk intake (p = 0.04). Among infants receiving > 75% human milk, there was no significant difference in change in weight z-score by milk type (donor ?0.84, maternal ?0.56, mixed ?0.45, p = 0.54). Infants receiving >75% donor milk had higher rates of SGA status at discharge than those fed maternal or mixed milk (56% vs. 35% (maternal), 21% (mixed), p = 0.08).VLBW infants can grow appropriately when fed predominantly fortified human milk. However, VLBW infants fed >75% human milk are at greater risk of poor growth than those fed less human milk. This risk may be highest in those fed predominantly donor human milk.Maternal milk diets have been associated with advantages for extremely low birthweight (ELBW) infants. ELBW infants fed maternal milk have lower rates of necrotizing enterocolitis (NEC) [1-3], the combined outcome of NEC or death [4], late onset sepsis [2,5,6], and have superior neurodevelopmental outcomes compared with those fed preterm formulas [7,8].However, maternal milk diets have also been associated with inferior in-hospital growth when compared with preterm formula. Studies performed prior to the current practice of human milk fortification demonstrated poorer growth in maternal–milk-fed infants compared with those fed formula [9], although neurodevelopmental advantages were associated with human milk intake [7,10]. Results of subsequent


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