613 - Evaluation of an association between transient hypoglycemia and human milk fortifiers in preterm infants less than 30 weeks

Publication Number: 613.4982

Maria M. Talavera-Barber, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, United States; Lisa M. Jorgenson, Avera McKennan Hospital, Sioux Falls, SD, United States; Jen May, Avera McKennan Hospital, Dell Rapids, SD, United States; Lacey A. McCormack, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, United States

Background: To achieve adequate macro-and micronutrient levels, preterm (PT) infants require fortification of human milk feedings. Currently available fortification products are classified as bovine protein-based human milk fortifiers (BOV-HMF) or human milk- derived human milk fortifiers (HM-HMF). Two recent studies reported significantly more hypoglycemia events in those preterm infants fed HM-HMF compared to BOV-HMF requiring feeding extension or other interventions.

Objective: The objective of this study was to examine if our PT population demonstrated the same pattern of hypoglycemia associated with exclusive human milk feedings when compared to bovine-fortified human milk feedings.

Design/Methods: This is a retrospective cohort study of 86 PT infants born < 30 weeks gestational age (GA) between 2018-2022 at a level III NICU who were categorized as receiving breastmilk with BOV-HMF (n=61) and infants fortified with HM-HMF (n=25). Characteristics including sex, race, GA, and birthweight (BW), along with nutritional interventions such as average protein on day of life (DOL) 7-14, DOL of full feedings, and DOL of fortification were examined for differences using chi-square tests and t-tests. Means ± SD are reported. Hypoglycemia was defined as < 60mg/dL after 1 week from reaching full enteral feeds of 140ml/kg/day. Human milk feedings include maternal and donor human milk feedings. Exclusions include small for gestational age (SGA) infants, infants with sepsis or genetic cause of hypoglycemia. Regression analyses examined any hypoglycemia event while controlling for characteristics that differed between groups (BW and GA). Statistical significance was determined using a p< 0.05.

Results: The study sample (n=86) was majority male (56%) and non-Hispanic white (81%). Characteristics that differed between BOV-HMF and HM-HMF infants included GA in weeks (28.0 ± 1.5 vs 26.1 ± 1.7, p< 0.0001) and BW in grams (1147 ± vs 945 ± 250, p< 0.0011). Z-scores at birth for HC, length, and weight did not differ statistically between groups (all p>0.05). Weight at which fortification started did not differ (1107 ± 213 vs 1028 ± 268, p=0.1541). Hypoglycemia incidence did not differ between BOV-HMF and HM-HMF groups (p=0.528) one week after reaching full feeds.

Conclusion(s): An exclusive human milk diet was not associated with hypoglycemia events after tolerating full enteral feeds in preterm infants < 30 weeks GA. Contrary to existing evidence, fortification type may not be the sole driver of transient hypoglycemia in PT infants.

Table 1. Unadjusted characteristics of study sample (n=86) overall and by fortification method at time of full feeds
n (column %), mean ± SD
* NS when categorized all race categories examined individually



Hypoglycemia outcome by fortification method at the time of full feeds