The trial that I mentioned in my previous post on this topic, that I said had not been published, has now been published! O’Connor DL, et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. The American journal of clinical nutrition. 2018.
Thanks to Cindy Ulrich from Toronto who gave me the heads up. The new publication reports a trial that (in both groups) supplemented mothers milk with pasteurized banked human milk when necessary, and compared fortification of the milk with either a human milk based fortifier or a bovine-protein based fortifier.
Unfortunately there were only 127 babies randomized, which limits the power of the trial for clinically important outcomes. Nevertheless, they showed no difference in any outcome. All of the outcomes were very similar between human milk based fortification, and cows’ milk based fortification.
In specific terms there were just under 5% of cases of NEC stage 2o or more in the 2 groups. That is 3 babies in each group.
For now the implication of this trial is that, when a mother of a very preterm baby wants to breast feed, if there is not enough milk and the baby needs a supplement, then pasteurized donated human milk is the optimal source. Once the TPN is being withdrawn, and the baby needs fortification of their feeds, there is no clear advantage of either a human-milk based fortifier, or a bovine based fortifier, on clinically important outcomes.