Post Discharge Human Milk Fortifier in Preterm Infants

Consensus exists in the literature that a significant proportion of low birth weight (LBW, <1800 g) infants leave hospital with overt signs of under-nutrition (eg. growth retardation). Recent evidence from randomized control trials suggest that provision of nutrient-enriched feeding to formula-fed premature infants after hospital discharge improves their growth, accretion of lean body mass and bone mineral content compared to infants fed a standard term formula. While available data suggest an advantage of human milk feeding after hospital discharge, experimental evidence on which to base guidelines to enrich, or not to enrich, human milk (HM) are notably absent.

Inclusion criteria

• Birth Weight between 750-1800 g
• Gestational Age at birth between 26 and 32 weeks
• Singleton or twin birth (for twins to be eligible, both must meet eligibility criteria)
• Small for Gestational age or appropriate for gestational age
• ≥ 80% energy received from human milk in the previous three days
• ≥ 25% of human milk consumed orally in the previous three days
• Mother agrees to exclusively feed her infant human nilk after discharge
• If so randomized, parents agree to supplement ~1/2 or the human milk provided to her infant as powdered human milk fortifier for 12 weeks after hospital discharge
• Subject's parents have voluntarily signed an informed consent form

Exclusion criteria

• Serious congenital or chromosomal anomalies that will affect growth
• Grade III or IV periventricular/intraventricular hemorrhage
• Received steroids within 14 days o randomization
• Asphyxia (hypoxia or ischemia) es evident by severe and permanent neurological data
• Maternal incapacity, including maternal cocaine or alcohol abuse dring pregnancy, or concurrent, or mother or infant has tested positive for HIV
• Principal residence of study family outside GTA
• Mother unable to verbally communicate in English
• A single feeding must be fortified > 24 kcal/oz or >50% of feeds need to be fortified