440 - Human Milk-Derived Fortifiers are Associated with Increased Hypoglycemia and Extended Feeds: A Retrospective Chart Review

Poster Number: 440
Publication Number: 440.334

Danielle E. Ackley, University of Rochester School of Medicine and Dentistry, Webster, NY, United States; Hongyue Wang, University of Rochester, Rochester, NY, United States; Carl DAngio, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Jeff Meyers, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Bridget E. Young, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States

Background: In late 2017, our level IV NICU transitioned from providing bovine-derived human milk fortifiers (Bov-fort) to human milk-derived fortifiers (HM-fort) and donor human milk (when mother’s milk unavailable) to infants born < 1250g or < 30 weeks gestation.

Objective: To investigate anecdotal provider reports that switching from a Bov-fort to HM-fort diet was associated with higher rates of hypoglycemia resulting in extended feed duration.

Design/Methods: We conducted a retrospective chart review of all infants receiving 30 (n=2), 28 (n=7), and 26 kcal/oz HM-fort (n=16) and 24 randomly selected infants receiving 24 kcal/oz HM-fort. We matched these infants with those receiving equivalent kcal/oz Bov-fort over the same number of days, matching infant sex, gestational age (GA), age, and birth weight. Infant blood glucose measurements and feed orders were retrieved from the electronic medical record after matching. Generalized estimating equation models were used to compare the proportion of days with: any feed extension orders, feed extensions due to hypoglycemia, and hypoglycemic blood glucose determinations between matched groups. The McNemar test was used to compare between groups whether hypoglycemia or extended feeds ever occurred.

Results: 98 patient charts were reviewed (49 HM-fort; 49 matched Bov-fort). Mean GA for HM-fort and Bov-fort groups was 26.7±2.0 and 26.6±1.9 weeks, respectively (p=0.74). Mean age at first day of relevant fortification was 27±15 and 29±14 days (p=0.31). In the HM-fort group, at least one hypoglycemic blood glucose ( < 60 mg/dL) was detected in 36.7% of infants vs. 22.5% in the Bov-fort group (p=0.002). Using a cutoff of ≤45 mg/dL, the HM-fort group exhibited at least one hypoglycemic event in 17.4% vs 4.3% in the Bov-fort infants (p < 0.001). The proportion of hypoglycemia recorded ( < 60 mg/dL) was 3.46 times higher in the HM-fort infants compared to matched Bov-fort infants (p=0.008; 95% CI: 1.375-8.696). Feeds were extended for any reason in 55% of HM-fort infants vs. 20% of matched Bov-infants (p=0.034).  Rate of days with extended feeds was 2.73 times higher in HM-fort vs matched Bov-fort infants (p=0.0002, 95% CI: 1.601-4.653). Feed extension because of hypoglycemia occurred in 24% of HM-fort infants vs. 0% of matched Bov-fort infants (p < 0.0001).Conclusion(s): These retrospective results support anecdotes that a HM-fort diet is associated with higher rates of hypoglycemia and resulting orders for extended feeds compared to Bov-fort in infants < 30 weeks or < 1250g at birth. Prospective research is warranted to confirm these results and elucidate underlying mechanisms.
Table 1: Differences in Glycemic Outcomes between Matched Infants receiving Bovine vs. Human Milk-Derived Fortifiers1. Results reported as mean ± standard deviation unless otherwise noted.
Infants matched on sex, gestational age, age, birth weight and caloric density