Impact of Different Feeding Strategies on Growth Outcomes in Very Low Birth Weight Infants

The goal of a study was to evaluate growth trajectories of preterm, very low birth weight (VLBW) infants who are appropriate for gestational age (AGA) under three different feeding strategies.

This study entailed a prospective, open-label, three-arm parallel randomized controlled trial, conducted in the neonatal intensive care unit at Kasturba Hospital, Manipal. From April 2021 to September 2022, 120 VLBW preterm AGA infants (weighing 1000-1500 g; gestational age 28-32 weeks) were included in the study. The feeding regimens compared were expressed breast milk (EBM), EBM with human milk fortifier (HMF), and EBM with preterm formula feed (PTF). Growth parameters—weight, length, and head circumference—were assessed at birth, 2, 3, 4, 5, and 6 weeks, or discharge. Secondary outcomes included incidence of co-morbidities and cost-effectiveness.

Among the 112 infants analyzed, those in the HMF group exhibited superior growth outcomes by the 6th week or discharge, with a mean weight of 2053±251 g, mean length of 44.6±1.9 cm, and mean head circumference of 32.9±1.4 cm. Infants receiving PTF had a mean weight of 1968±203 g, mean length of 43.6±2.0 cm, and mean head circumference of 32.0±1.6 cm. Exclusively EBM-fed infants showed a mean weight of 1873±256 g, mean length of 43.0±2.0 cm, and mean head circumference of 31.4±1.6 cm. 

Hence, the addition of 1 g of HMF to 25 ml of EBM led to significantly better weight gain and head circumference by the 6th week. However, no significant differences were noted at earlier time points. The results underscored that while HMF supplementation improves growth parameters significantly, it also comes with higher costs and potential feed intolerance. Continued research is needed to explore the long-term impacts and safety of HMF supplementation.

Source: Pedaveeti M, Iqbal F, Purkayastha J, et al. Indian Journal of Pediatrics. 2024 Jan 11:1-7.