A Pilot study to examine human milk versus formula feeding among preterm infants: short term outcomes

Dr Lok, Yuet Wan Kris   (Principal Investigator (PI))

Professor Tarrant Agnes Marie   (Co-Investigator)

20

2014-06-30

50527

A Pilot study to examine human milk versus formula feeding among preterm infants: short term outcomes

neonatal nutrition, neonatal outcome, preterm infants

Paediatrics,Neonatology

201309176063

Small Project Funding

2013

Completed

Preterm birth is a leading cause of infant mortality, morbidity and long-term disability among children under five years.[1] Annually, around 1 million children die due to complications of preterm birth and result in significant health care costs that increase exponentially with decreasing gestational age and weight.[2] Hong Kong is a developed non-Western setting, with a level of economic development and social infrastructure similar to northern Europe or North America.[3] With older age at pregnancy and more cesarean deliveries, the proportion of premature births among all pregnancies increased from 5.7% to 6.7% between 1994 and 2004.[4] The primary acquired disease of preterm infants is necrotizing enterocolitis (NEC) affecting approximately 10% of very low birth weight infants (VLBW<1500g). Several studies have described the long-term outcomes of NEC with respect to the need for surgery,[5, 6] death, [6, 7] the development of short gut [6, 8] and the occurrence of abdominal adhesions. [8, 9] Infants with NEC often require ventilator and oxygen support. [10, 11] Also infants who require surgery for NEC develop more morbidity, such as infection, retinopathy of prematurity (ROP) or bronchopulmonary dysplasia (BPD), which lengthen hospital stay.[12-14] Another concern includes bacterial infections that continue to cause a high burden in neonatal morbidity and mortality, ranging from 10-30%[15] that can cause BPD, brain injury and ROP[16]. Studies based predominately on infants born in the 1990s demonstrated that neonatal infections were associated with an increased risk of poor developmental outcomes.[17, 18] Surviving premature infants with significant neurologic disabilities remains high, such as cerebral palsy and neurodevelopmental impairment.[19, 20] It is therefore crucial that every attempt is made to minimize potential contributing factors that are modifiable to reduce incidence of these complications during hospitalization. For cost-effective care related to preterm infants, the World Health Organization (WHO) recommend kangaroo mother care (skin to skin contact) and frequent breastfeeding.[1] The American Academy of Pediatrics now recommends that, under most circumstances, fortified human milk is the feeding choice for hospitalized VLBW infants that potentially reduce the incidence of sepsis and NEC.[21] Considering the low costs involved in implementation of feeding mother’s own milk, the observed benefits are clearly worth the costs. These recommendations are supported through some hospitals in the Hospital Authority and VLBW infants are predominantly fed both fortified breast milk and preterm formula in Hong Kong. However current feeding practices vary across different neonatal intensive care unit (NICU) settings with no standardized feeding protocol. According to the WHO optimal feeding of LBW infants, preterm infants may benefit from avoidance of full enteral feeds on the first day of life. They also recommend trophic feeding or minimal enteral nutrition thereafter e.g. 5-10ml/kg/day.[22] Policy statements from WHO confirm standard practice in neonatal units is to promote mother’s own milk as the feed of choice for all LBW infants.[22] In one of the few prospective, randomized controlled trials of donor breast milk compared to preterm formula, preterm babies fed breast milk had fewer episodes of infection-related events and shorter duration of hospital stay.[23] Studies performed prior to current practice of human milk fortification have been mixed, the relationship between fortified breast milk have been uncertain when donor human milk are considered. The uptake of breast milk in preterm infants among Hong Kong women however, is uncertain as no studies have been conducted. Data from other countries composed predominantly of fortified donor breast milk. Few published data exist to date that directly examine the short term outcomes of preterm infants fed fortified human milk compared with specially designed nutrient-enriched formulas during hospitalization. Therefore the proposed study seeks to add to existing literature gap to examine the growth and infection rate between the proportion of fortified breast milk and preterm formula among preterm babies of VLBW. The current situation in Hong Kong provides a unique opportunity to examine the effect of fortified breast milk compared to formula milk as they do not use donor milk banks. Also, in Hong Kong there is little information on feeding preterm infants and the potential effect it has on their growth and infection rate during hospitalization. If proven effective, we can encourage and reinforce the importance to follow the WHO recommendation for breastfeeding in neonatal units as well as reducing neonatal complications. It will also provide a platform for future studies at a larger multi-centre cohort study. Therefore, the aim of this study is to compare the growth and infection rate of VLBW infants fed different amounts of human milk and nutrient-enriched formulas until discharged.