632 - Individualized Breast Milk Fortification in a Level 3 NICU

Publication Number: 632.5205

Robert B. Manges, Baystate Children's Hospital, West Springfield, MA, United States; Laura Madore, Baystate Children's Hospital, Division of Newborn Medicine, Springfield, MA, United States

Background: Breast milk (BM) requires supplemental fortification to achieve optimal caloric and protein requirements for adequate growth and lean body mass accrual in preterm infants. Targeted fortification (TF) utilizes a human milk analyzer (HMA) to assess the macronutrients of BM and allows for accurate fortifying to targeted goals. Limited studies exist that evaluate TF and its effect on body composition in preterm infants.

Objective: We compared body composition (primary outcome) and overall growth of preterm infants fed TF BM versus standard fortified BM. We hypothesize that TF using an HMA will improve discharge fat-free mass.

Design/Methods: This is a single-center, randomized controlled study of non-growth restricted infants of 26 0/7 - 31 6/7 weeks gestational age (GA) on full enteral feeds of mother’s and/or donor milk fortified using cow’s milk-based fortifier. The TF group received caloric adjustments based on BM macronutrients measured by an FDA-approved HMA; the control fortification (CF) group received fortification based upon BM standard assumptions with enteral goal of ~160ml/kg/day. Based on weekly growth, and HMA results in the TF group, feeds were adjusted to meet ESPGHAN goals by adding modulars, increasing fortifier, and/or adjusting total fluid goal. Collected data included discharge fat and fat-free mass via air-displacement plethysmography, growth (Fenton 2013), weekly caloric intake, nutritional labs, basic demographic and morbidity data, and neurodevelopmental data at ~2 years. Comparisons of categorical data were via Fisher’s exact test and continuous data via Student’s t test.

Results: 32 infants were enrolled (TF n=15; CF n=17). There were no differences in GA, sex, ethnicity, z-score birth measurements, and feeding parameters (fortification initiation, day to reach full feeds, intolerance and NPO days); the TF group had a higher % of donor milk intake which had less protein in base milk. The TF group had more weekly nutritional adjustments (53% vs 20.5%; p< 0.001) and protein addition (p=0.01), and at discharge, had a higher mean fat-free mass (80.3±4.2% vs 77.5±2.4%; p = 0.04) and a corresponding lower fat mass (19.7±4.2% vs 22.5±2.4%; p = 0.04). There were no differences between groups in morbidities, caloric intake, nutritional labs, growth, discharge z-score measurements, or in neurodevelopmental outcomes at ~2 years.

Conclusion(s): While overall growth was unchanged, there is an association between HMA-assisted targeted fortification, increased protein supplementation, and improved lean body mass at discharge among enrolled preterm infants without any noted complications.