Biochemical response in preterm infants fed a human versus bovine milk-based fortifier

Access through your institution Buy or subscribe Human milk alone has insufficient nutrients to meet preterm infant requirements and a multi-nutrient fortifier, bovine milk-based (BMBF) or

human milk-based (HMBF), is recommended. As the nutrient composition of BMBF and HMBF differs [1, 2], the biochemical effects may also differ; these differences have not yet been reported.

This secondary analysis of a randomized controlled trial comparing BMBF and HMBF examined the biochemical response to the different fortifiers in preterm infants which were hypothesized to

differ given different intakes of protein and iron [3]. Infants born <1250 g who met eligibility criteria for the Optimizing Mothers’ Milk for Preterm Infants (OptiMoM) trial

(NCT02137473) were studied [3]. Following informed consent, infants were provided mother’s milk first then pasteurized donor milk as required and had BMBF or HMBF added to human milk feeds

in a blinded fashion depending on their randomization. The HMBF group received Prolact+4 and +6 (Prolacta Bioscience, City of Industry, USA) commencing at 100 mL/kg/day (81 kcal/dL, 2.2 g/dL

protein, 0.1 mg/dL iron) and 140 mL/kg/day (88 kcal/dL, 2.7 g/dL protein, 0.2 mg/dL iron), respectively. In the BMBF group, 0.4 g/dL intact protein modular (Beneprotein, Nestle,

Minneapolis, USA) was added to donor milk and Similac Human Milk Fortifier (Abbott Nutrition, Columbus, USA) 1:50 and 1:25 commenced at 100 mL/kg/day (72 kcal/dL, 1.7 g/dL protein, 0.2 mg/dL

iron) and 140 mL/kg/day (78 kcal/dL, 2.2 g/dL protein, 0.4 mg/dL iron), respectively. Parenteral nutrition was discontinued at 120 mL/kg/day, enteral volumes increased 10-25 mL/kg/day, full

feeds were considered 160 mL/kg/day, and energy increases were implemented if weight gain was <15 g/kg/day using Prolact+8 (95 kcal/dL) or Neosure (88 kcal/dL, Abbott Nutrition,

Columbus, USA) in HMBF and BMBF groups, respectively. Both groups received multivitamin drops containing 375IU vitamin A, 200IU vitamin D and 17.5 mg vitamin C daily. Vitamin D 200IU was

given daily until 2 kg. Each infant received 2-3 mg/kg/day elemental iron after full fortification. These doses were chosen bearing in mind the different micronutrient composition of the two

diets while providing the same supplementation to both groups and thus maintaining blinding. The intervention lasted until 84 days of age, hospital discharge or establishment of oral feeds.

The initial trial found no group differences in feeding tolerance or growth [3]. This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your

institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access

to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read

our FAQs * Contact customer support REFERENCES * Prolact+ H2MF. 2022. Prolacta Bioscience. https://www.prolacta.com/en/products/preterm-nutrition-products/#fortifier * Similac Human Milk

Fortifier Powder. 2023. Abbott. https://abbottnutrition.com/similac-human-milk-fortifier-powder * O’Connor DL, Kiss A, Tomlinson C, Bando N, Bayliss A, Campbell DM, et al. Nutrient

enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am J Clin Nutr. 2018;108:108–16. Article  PubMed 

Google Scholar  * Thoene M, Hanson C, Lyden E, Dugick L, Ruybal L, Anderson-Berry A. Comparison of the effect of two human milk fortifiers on clinical outcomes in premature infants.

Nutrients. 2014;6:261–75. Article  CAS  PubMed  PubMed Central  Google Scholar  * Schanler RJ, Groh-Wargo SL, Barrett-Reis B, White RD, Ahmad KA, Oliver J, et al. Improved outcomes in

preterm infants fed a nonacidified liquid human milk fortifier: a prospective randomized clinical trial. J Pediatr. 2018;202:31–7.e2. Article  PubMed  Google Scholar  Download references

FUNDING Canadian Institutes of Health Research FHG129919, FDN143233. AUTHOR INFORMATION Author notes * These authors contributed equally: Phoebe Kigozi, Nicole Bando. AUTHORS AND

AFFILIATIONS * Paediatrics, Sinai Health, Toronto, ON, Canada Phoebe Kigozi, Nicole Bando, Roselina Mahlase, Kirsten Kotsopoulos, Deborah L. O’Connor & Sharon Unger * Paediatrics,

Nottingham University Hospitals, Nottingham, UK Phoebe Kigozi * Paediatrics, University of the Witwatersrand, Johannesburg, South Africa Roselina Mahlase * Nutritional Sciences, University

of Toronto, Toronto, ON, Canada Deborah L. O’Connor & Sharon Unger * Izaak Walton Killam Health Centre, Halifax, NS, Canada Sharon Unger Authors * Phoebe Kigozi View author publications

You can also search for this author inPubMed Google Scholar * Nicole Bando View author publications You can also search for this author inPubMed Google Scholar * Roselina Mahlase View author

publications You can also search for this author inPubMed Google Scholar * Kirsten Kotsopoulos View author publications You can also search for this author inPubMed Google Scholar * Deborah

L. O’Connor View author publications You can also search for this author inPubMed Google Scholar * Sharon Unger View author publications You can also search for this author inPubMed Google

Scholar CONTRIBUTIONS PK, DLO, SU contributed to the design of the research; PK, NB, RM, KK contributed to the acquisition, analysis, or interpretation of the data. All authors participated

in drafting or reviewing the work critically for important intellectual content, approve the final version to be published, and agree to be accountable for all aspects of the work.

CORRESPONDING AUTHOR Correspondence to Sharon Unger. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer

Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Springer Nature or its licensor (e.g. a society or other

partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this

article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kigozi, P., Bando, N., Mahlase, R. _et

al._ Biochemical response in preterm infants fed a human versus bovine milk-based fortifier. _J Perinatol_ 44, 1689–1691 (2024). https://doi.org/10.1038/s41372-024-02089-w Download citation

* Received: 10 December 2023 * Revised: 15 July 2024 * Accepted: 30 July 2024 * Published: 16 August 2024 * Issue Date: November 2024 * DOI: https://doi.org/10.1038/s41372-024-02089-w SHARE

THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to

clipboard Provided by the Springer Nature SharedIt content-sharing initiative