P2C337: Got Milk?: Growth Impacts of H(2)MF

Background: Human milk fortifiers (HMF) are the preferred form of caloric fortification to enhance nutrition for premature infants. At our institution’s NICU, Prolact(TM) H(2)MF, a human milk-based fortifier, is the primary fortifier until transition to non-human milk-based fortifier (HMF) at 34 weeks of age. H2MF is utilized to increase nutritional content and decrease adverse events associated with HMF. Data regarding the long-term nutritive benefits and growth of infants who receive H(2)MF is lacking.

Methods: A retrospective chart review of 157 infants born between December 2019 and December 2021 who received H(2)MF. Those with severe cardiopulmonary, gastrointestinal disease, sepsis or requirements for any surgical intervention during NICU stay were excluded. Infant birth gestational age ranged from 24 to 31wga and birth weight from 420gm to 1480gm, with means of 27wga and 931gms. Growth metrics (weight, length via length board, and head circumference) were measured at 3 points: start of H(2)MF (mean: 28cga, 952gm), transition off H(2)MF to HMF (mean: 34cga, 1728gm), and discharge (mean: 40cga, 2897gm). With the corrected gestational age at each point, infant measures were standardized based on the Fenton growth curve. Analysis using row matching, one-way ANOVA with Tukey post hoc test was performed on demographics and growth metric z-scores at the specified points; p< 0.05 was considered statistically significant.

Results: Study data demonstrated a statistically significant increase in negative z-score for weight and length of infants receiving H(2)MF (0.471, p< 0.0001; 0.946, p< 0.0001), which was not observed for infants receiving HMF (0.073, p=0.5022; 0.242, p=0.0377). Gender, race and milk base were independently analyzed for weight and demonstrated the same trends as the whole. Head circumference analysis did not demonstrate a statistically significant negative z-score change for infants on H(2)MF (0.213, p=0.221), however, a positive z-score trend was observed for infants receiving HMF (0.797, p< 0.0001).

Conclusion: Positive growth trajectory of infants on H(2)MF is hindered in regard to weight and length. Transition to HMF slows the negative trend in these metrics and may, with further recovery time, provide growth. The investigated institution’s current nutrition policy does not provide enough recovery growth time to fully assess this assertion. Head circumference, although demonstrating a different finding, provides support to this theory when considering the length time needed for nutrition to detrimentally affect infant head circumference; observing no significant trend while on H(2)MF followed by a statistically significant positive trend following transition to HMF indicates growth discrepancies between the fortifiers. We propose that a novel nutrition protocol, with transition from H(2)MF at an earlier corrected gestational age, will improve growth outcomes.