Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial
IntroductionVery-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.MethodsWe designed a randomized controlled trial to determine whether...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-08-01
|
| Series: | Frontiers in Nutrition |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2025.1582519/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849330215874985984 |
|---|---|
| author | Chengsi Ong Anng Anng Wong Siew Tin Wong Ying Zheng Cynthia Pui Chan Pang Cynthia Pui Chan Pang Pooja Agarwal Jayagobi Pooja Agarwal Jayagobi Joo Guan Yeo Joo Guan Yeo Joo Guan Yeo Kee Thai Yeo Kee Thai Yeo Mei Chien Chua Mei Chien Chua Mei Chien Chua |
| author_facet | Chengsi Ong Anng Anng Wong Siew Tin Wong Ying Zheng Cynthia Pui Chan Pang Cynthia Pui Chan Pang Pooja Agarwal Jayagobi Pooja Agarwal Jayagobi Joo Guan Yeo Joo Guan Yeo Joo Guan Yeo Kee Thai Yeo Kee Thai Yeo Mei Chien Chua Mei Chien Chua Mei Chien Chua |
| author_sort | Chengsi Ong |
| collection | DOAJ |
| description | IntroductionVery-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.MethodsWe designed a randomized controlled trial to determine whether an enhanced method of fortification (EF) improved growth in VLBW infants compared to standard fortification (SF). VLBW infants admitted to our tertiary-level neonatal intensive care unit were randomized to receive a bovine powdered human milk fortifier (HMF) added to PDHM (SF), or specially selected high-fat PDHM (fat concentration ≥3.8 g/dL) with bovine powdered HMF and a liquid protein fortifier providing an additional 0.67 g/dL protein (EF). Primary outcome was impaired weight gain defined as weight z-score drop of ≥0.8 from birth at 37 weeks or hospital discharge, whichever earlier. Secondary outcomes included change in length and head circumference (HC) z-scores from birth, requirement for high calorie formula, and rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP).ResultsA total of 61 infants were randomized (31 SF, 30 EF). Impaired weight gain was not significantly different (SF 83.9% vs. EF 73.3%, p = 0.347), with similar declines in weight z-scores from birth in both groups SF −1.27 [interquartile range (IQR) −1.71, −0.87] vs. EF −1.13 (IQR −1.46, −0.78), p = 0.403. However, the EF group had a smaller decline in length and HC z-scores from birth to discharge compared to the SF group [Length z-score change: −0.92 (IQR −1.64, −0.48) vs. −1.64 (IQR −2.21, −0.89), p = 0.007; HC z-score change: −0.08 (IQR −0.74,0.58) vs. −0.86 (IQR −1.81, −0.21), p = 0.014]. The EF group also required less high calorie formula supplementation [0% (IQR 0-4.1) vs. 3.8% (IQR 0 −16.9), p = 0.032]. Rates of BPD and ROP were not significantly different between groups.ConclusionAmong VLBW infants, EF did not improve weight gain, but reduced declines in HC and linear growth compared to SF. |
| format | Article |
| id | doaj-art-da4b74b95468468097c2e40356782daa |
| institution | Kabale University |
| issn | 2296-861X |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj-art-da4b74b95468468097c2e40356782daa2025-08-20T03:47:02ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2025-08-011210.3389/fnut.2025.15825191582519Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trialChengsi Ong0Anng Anng Wong1Siew Tin Wong2Ying Zheng3Cynthia Pui Chan Pang4Cynthia Pui Chan Pang5Pooja Agarwal Jayagobi6Pooja Agarwal Jayagobi7Joo Guan Yeo8Joo Guan Yeo9Joo Guan Yeo10Kee Thai Yeo11Kee Thai Yeo12Mei Chien Chua13Mei Chien Chua14Mei Chien Chua15Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, SingaporeKK Human Milk Bank, Singapore, SingaporeKK Human Milk Bank, Singapore, SingaporeKK Human Milk Bank, Singapore, SingaporeKK Human Milk Bank, Singapore, SingaporeDivision of Nursing, Lactation Services, Singapore, SingaporeKK Human Milk Bank, Singapore, SingaporeDepartment of Neonatology, KK Women's and Children's Hospital, Singapore, SingaporeDuke-NUS Medical School, Singapore, SingaporeDivision of Medicine, KK Women's and Children's Hospital, Singapore, SingaporeSingHealth Duke-NUS Academic Medical Centre, Translational Immunology Institute, Singapore, SingaporeDepartment of Neonatology, KK Women's and Children's Hospital, Singapore, SingaporeDuke-NUS Medical School, Singapore, SingaporeKK Human Milk Bank, Singapore, SingaporeDepartment of Neonatology, KK Women's and Children's Hospital, Singapore, SingaporeDuke-NUS Medical School, Singapore, SingaporeIntroductionVery-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.MethodsWe designed a randomized controlled trial to determine whether an enhanced method of fortification (EF) improved growth in VLBW infants compared to standard fortification (SF). VLBW infants admitted to our tertiary-level neonatal intensive care unit were randomized to receive a bovine powdered human milk fortifier (HMF) added to PDHM (SF), or specially selected high-fat PDHM (fat concentration ≥3.8 g/dL) with bovine powdered HMF and a liquid protein fortifier providing an additional 0.67 g/dL protein (EF). Primary outcome was impaired weight gain defined as weight z-score drop of ≥0.8 from birth at 37 weeks or hospital discharge, whichever earlier. Secondary outcomes included change in length and head circumference (HC) z-scores from birth, requirement for high calorie formula, and rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP).ResultsA total of 61 infants were randomized (31 SF, 30 EF). Impaired weight gain was not significantly different (SF 83.9% vs. EF 73.3%, p = 0.347), with similar declines in weight z-scores from birth in both groups SF −1.27 [interquartile range (IQR) −1.71, −0.87] vs. EF −1.13 (IQR −1.46, −0.78), p = 0.403. However, the EF group had a smaller decline in length and HC z-scores from birth to discharge compared to the SF group [Length z-score change: −0.92 (IQR −1.64, −0.48) vs. −1.64 (IQR −2.21, −0.89), p = 0.007; HC z-score change: −0.08 (IQR −0.74,0.58) vs. −0.86 (IQR −1.81, −0.21), p = 0.014]. The EF group also required less high calorie formula supplementation [0% (IQR 0-4.1) vs. 3.8% (IQR 0 −16.9), p = 0.032]. Rates of BPD and ROP were not significantly different between groups.ConclusionAmong VLBW infants, EF did not improve weight gain, but reduced declines in HC and linear growth compared to SF.https://www.frontiersin.org/articles/10.3389/fnut.2025.1582519/fulldonor breast milkgrowthvery low birth weightpretermfortification |
| spellingShingle | Chengsi Ong Anng Anng Wong Siew Tin Wong Ying Zheng Cynthia Pui Chan Pang Cynthia Pui Chan Pang Pooja Agarwal Jayagobi Pooja Agarwal Jayagobi Joo Guan Yeo Joo Guan Yeo Joo Guan Yeo Kee Thai Yeo Kee Thai Yeo Mei Chien Chua Mei Chien Chua Mei Chien Chua Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial Frontiers in Nutrition donor breast milk growth very low birth weight preterm fortification |
| title | Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial |
| title_full | Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial |
| title_fullStr | Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial |
| title_full_unstemmed | Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial |
| title_short | Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial |
| title_sort | enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants a randomized controlled trial |
| topic | donor breast milk growth very low birth weight preterm fortification |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2025.1582519/full |
| work_keys_str_mv | AT chengsiong enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT annganngwong enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT siewtinwong enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT yingzheng enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT cynthiapuichanpang enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT cynthiapuichanpang enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT poojaagarwaljayagobi enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT poojaagarwaljayagobi enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT jooguanyeo enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT jooguanyeo enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT jooguanyeo enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT keethaiyeo enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT keethaiyeo enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT meichienchua enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT meichienchua enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial AT meichienchua enhancedversusstandardfortificationofpasteurizeddonorhumanmilkforgrowthinverylowbirthweightinfantsarandomizedcontrolledtrial |