Paeds Vivas · fetal-neonatal-and-perinatal
Human milk, fortification and preterm nutrition
Viva scenario on a preterm infant requiring fortification strategy discussion and human milk evidence.
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Branch 1: Assessment of growth
Examiner: This infant is growing poorly. What is your assessment? Expected response: She is 10 days old, so ESPGHAN 2022 would already have wanted birth weight regained by 7 to 10 days after a 7 to 10 percent early loss. Gain of 6 g/kg/day is below Ehrenkranz's 14.4 to 16.1 g/kg/day after regain and below the foetal guide of about 17 to 20 g/kg/day at 26 to 29 weeks. Unfortified milk at 120 mL/kg/day supplies about 1.2 g/kg/day protein if milk is 1 g/100 mL, versus at least 3.5 to 4.0 g/kg/day. Fortifier is overdue: the ESPGHAN start window is 40 to 100 mL/kg/day and she is already at 120 [1].
References4ShowHide
- [1]Embleton ND, Jennifer Moltu S, Lapillonne A, et al. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts J Pediatr Gastroenterol Nutr, 2023.PMID 36705703
- [2]Lucas A, Cole TJ Breast milk and neonatal necrotising enterocolitis Lancet, 1990.PMID 1979363
- [3]Sullivan S, Schanler RJ, Kim JH, et al An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products J Pediatr, 2010.PMID 20036378
- [4]Dorling J, Hewer O, Hurd M, et al Two speeds of increasing milk feeds for very preterm or very low-birthweight infants: the SIFT RCT Health Technol Assess, 2020.PMID 32342857