443 - Use of Human Milk Fortifier After NICU Discharge Improves Human Milk Usage Rates for Preterm Infants

Poster Number: 443

Lyssa Lamport, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Port Washington, NY, United States; Allison Siegel, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Feinstein Institute for Medical Research/Northwell, Boca Raton, FL, United States; Barry Weinberger, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Diana Maffei, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States

Background: Preterm infants are at risk for suboptimal growth during and after their NICU stay. Despite human milk being optimal nutrition, it does not meet the high energy and nutrient demands of preterm infants. During the NICU stay, expressed human milk (EHM) is mixed with commercial human milk fortifiers (HMF), which add carbohydrates and lipids to achieve higher caloric density, as well as protein, calcium, phosphorus, and other key nutrients. In contrast, the standard nutrition strategy for human milk-fed preterm infants discharged from NICU has been to enrich EHM with powdered post-discharge preterm infant formula and/or to supplement with 2-3 feeds per day of post-discharge preterm infant formula.

Objective: To evaluate the use of commercial HMF to fortify human milk feedings after NICU discharge, compared with the standard post-discharge nutrition strategy.

Design/Methods: Preterm infants ( < 34 weeks gestation at birth) feeding exclusive EHM 2 weeks prior to discharge were included. The “HMF” group (n=92) was provided HMF to continue at home after discharge. The “standard” group (n=35) was instructed to enrich EHM and/or supplement 2-3 feeds per day using post-discharge preterm infant formula. Z-scores for weight, length, and head circumference were assessed at discharge, 2-4 weeks (visit 1), 3 months (visit 2) and 6 months after discharge (visit 3). Rates of exclusive and any EHM feedings were assessed at discharge, visit 1, and visit 2.

Results: Continuation of HMF fortification increased exclusive EHM use at and after discharge, as expected by protocol. Of note, it also increased the rates of any EHM feedings at both visit 1 and visit 2 after discharge (p < .05) (Fig. 1). Fenton Z-scores for weight, length, and head circumference decreased from birth to NICU discharge and increased at successive outpatient visits but were not significantly different between the groups. There was a trend toward increased head circumference in the HMF group compared to the standard group after visit 2 (Fig. 2).Conclusion(s): Continuing EHM fortification with HMF after NICU discharge, rather than enriching or supplementing with post-discharge infant formula, increases rates of feeding any EHM for at least 3 months. The benefits of human milk for preterm infants are well known. Weight gain and linear growth accelerate after discharge but are similar between the feeding regimens and do not match gestational age-adjusted means for at least 6 months. Larger cohorts are needed to determine whether HMF fortification improves head growth after NICU discharge.
Figure 1: Human Milk Usage
Figure 2: Fenton Z-scores