NEW YORK (Reuters Health) – There is less risk of growth failure in human milk-fed premature infants when they’re given a human milk fortifier with extra protein, Australian researchers have shown.

In fact, “It is possible that a higher-protein fortifier than used in this study is needed,” they suggest in their report in the American Journal of Clinical Nutrition online February 1.

Carmel T Collins, with Flinders Medical Centre in Bedford Park, South Australia, and colleagues note that the growth of preterm neonates who are given human breast milk is often suboptimal compared to intrauterine growth rates, even when supplemented with a human milk fortifier (HMF). “Consequently the current concentration of extra protein provided by HMF (between 0.7 and 1.1 g/100 mL, depending on brand) is thought to be inadequate,” they explain

To investigate the effects of increasing the protein content, the team randomized 92 infants born at <31 wk gestation to receive HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) while they received expressed breast milk via a bottle or feeding tube. The two supplements were made isocaloric by adjusting the carbohydrate content.

The study continued until discharge or the estimated due date. At that point, the team found that mean length was not significantly different in the higher protein group (46.3 cm) than the standard protein group (45.5 cm; p=0.14). However, further analysis showed that the proportion of infants who were less than the 10th percentile for length was significantly lower in the higher-protein arm (21%) than in the standard-protein arm (31%; p=0.047).

Respective mean weights at study end were significantly different (2760 g vs. 2539 g; p=0.03), although the clinical significance of this is not clear since the rate of weight gain was similar in the two arms (24 vs 26 g/d; p=0.33), the authors note.

Overall, they conclude, “The findings of our study suggest that feeding HMF with a protein concentration of 1.4 g/100 mL results in less growth failure in preterm infants born <31 wk gestation.”

As mentioned, they think it possible that even higher protein fortification may be required for optimal growth. “To determine whether this is so,” they conclude, “sufficiently large randomized controlled trials that are powered for important clinical outcomes, including neurodevelopment, will be needed.”

SOURCE:
Effect of increasing protein content of human milk fortifier on growth in preterm infants born at <31 wk gestation: a randomized controlled trial

Am J Clin Nutr