More on breast milk fortification

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  Once the TPN is being withdrawn, and the baby needs fortification of their feeds, there is no clear advantage of either a human-milk based fortifier, or a bovine based fortifier, on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.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged , . Bookmark the permalink.

2 Responses to More on breast milk fortification

  1. Richard Powers says:

    Keith, Thanks for reviewing this issue. I am a practicing neonatologist in San Jose and not affiliated with any of the manufacturers of fortifiers. This is truly a hot topic as most hospitals would be anxious to halt the use of human milk-based fortifiers due to the extra expense. You mention the limitations of the study due to the small sample size. Doesn’t this essentially negate the conclusion that there’s no difference between the two fortification regimens? Were there power calculations in the design and if so what was it powered to show? Why such a small sample size? Sorry that I haven’t had the opportunity to review the original paper yet.
    Dick Powers, MD
    Pediatrix Neonatology of San Jose

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