438 - Early Target Protein Supplementation of Maternal Milk guided by Milk Analysis Improves Growth In Preterm Infants

Poster Number: 438
Publication Number: 438.334

AMIT CHANDEL, Atrium Health Wake Forest Baptist Medical Center, Winston -Salem, NC, United States; Molly Talman, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Jordan L. Schultz, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Kathleen G. Ayers, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States; Reilly B. Hicks, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States; Peter Porcelli, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States

Background: Preterm (PT) infants regularly demonstrate growth failure(GF) during hospital stay with over 50% of these infants at or below the 10% percentile at discharge. Maternal milk (MM) protein gradually decreases with time, leading to inadequate protein intake, and contributing to chronic GF. Many strategies are used to reduce PT postnatal chronic GF but it remains a persistent clinical challenge. Poor growth, especially head growth, is associated with poor long-term neurodevelopmental (ND) outcomes. Based on guided milk component analysis, a quality improvement initiative was implemented to provide target protein intake.

Objective: Improve PT infant growth with individualized target protein supplementation guided by milk analysis.

Design/Methods: Inclusion group (MM): PT infants < 31 weeks (wk) gestational age (GA) tolerating MM feeds (>120mL/kg/day) fully fortified with human milk fortifier (Similac) through 34 wk postmenstrual age (PMA) in year 2021. MM was analyzed, twice weekly by Miris Human Milk Analyzer, Uppsala, Sweden. Similac liquid protein was supplemented to 3g/100ml per ESPGHAN guidelines. Control group (CON):Infants in year 2021, receiving non-analyzed fully fortified standardized donor milk (Prolacta) were matched at a 2:1 ratio. CON infants received protein supplementation based on poor growth ,per dietician’s recommendation. Data collected included baseline demographics, total energy, total protein, protein supplement, peak blood urea (BUN), Z scores through 34 weeks PMA and growth parameters .Data were compared using Mann Whitney independent t-tests and Pearson’s correlation .The significance was set at p< 0.05.

Results: There were no differences in birth weight, length, head circumference (HC) and age at protein supplementation between MM (n=22) and CON (n=30) groups. Nutritionally, there were no differences in total energy and total protein intake (CON: 123.2 vs MM: 117.2 kcal/kg/day;CON:3.9 vs MM:4g/kg/d) .Daily weight gain, HC and weight percentiles at 34 wk PMA were greater in the MM analysis group (CON: 18.8 vs MM: 23.4 g/kg/d, p< 0.0002; CON: 0.74 vs MM: 0.98cm/wk, p< 0.006) and (CON:20.6 vs MM: 34.5 percentile, p< 0.001).Conclusion(s): PT infants who received individualized protein supplementation based on MM protein analysis showed improved growth parameters despite similar caloric and protein intake. There was a clinically insignificant higher peak BUN in CON group. We suggest expanding this practice of MM analysis and target supplementation to other macronutrients in MM, which may help to reduce chronic PT growth failure and potentially improve long-term ND outcomes.
 
Table 1Demographics
Table 2Results