Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight

Amy B. Hair, Cynthia L. Blanco, Alvaro G. Moreira, Keli M. Hawthorne, Martin L. Lee, David J. Rechtman, Steven A. Abrams

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

Objective To evaluate whether premature infants who received an exclusive human milk (HM)-based diet and a HM-derived cream supplement (cream) would have weight gain (g/kg/d) at least as good as infants receiving a standard feeding regimen (control).

Study design In a prospective noninferiority, randomized, unmasked study, infants with a birth weight 750-1250 g were randomly assigned to the control or cream group. The control group received mother's own milk or donor HM with donor HM-derived fortifier. The cream group received a HM-derived cream supplement if the energy density of the HM tested <20 kcal/oz using a near infrared HM analyzer. Infants were continued on the protocol until 36 weeks postmenstrual age. Primary outcomes included growth velocities and amount of donor HM-derived fortifier used. The hypothesis of noninferiority was established if the lower bound of the one-sided 95% CI for the difference in weight velocities exceeded -3 g/kg/day.

Results There were no differences between groups in baseline demographics for the 78 infants studied except racial distribution (P =.02). The cream group (n = 39) had superior weight (14.0 ± 2.5 vs 12.4 ± 3.0 g/kg/d, P =.03) and length (1.03 ± 0.33 vs 0.83 ± 0.41 cm/wk, P =.02) velocity compared with the control group (n = 39). There were no significant differences in amount of fortifier used between study groups. The 1-sided 95% lower bound of the CI for the difference in mean velocity (cream-control) was 0.38 g/kg/d.

Conclusions Premature infants who received HM-derived cream to fortified HM had improved weight and length velocity compared with the control group. HM-derived cream should be considered an adjunctive supplement to an exclusive HM-based diet to improve growth rates in premature infants.

Original languageEnglish (US)
Pages (from-to)915-920
Number of pages6
JournalJournal of Pediatrics
Volume165
Issue number5
DOIs
StatePublished - Nov 1 2014

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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