Open AccessPreterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk
Author(s) -
Alan Lucas,
John Boscardin,
Steven A. Abrams
Publication year - 2020
Publication title -
breastfeeding medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.661
H-Index - 45
eISSN - 1556-8342
pISSN - 1556-8253
DOI - 10.1089/bfm.2019.0133
Subject(s) - medicine , necrotizing enterocolitis , breastfeeding , adverse effect , pediatrics , randomized controlled trial , relative risk , infant formula , obstetrics , confidence interval
Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis ( n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 ( p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain ( p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death.