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A Fortified Donor Milk Policy is Associated With Improved In-Hospital Head Growth and Weight Gain in Very Low-Birth-Weight Infants

Ginovart, Gemma MD; Gich, Ignasi MD; Gutiérrez, Antonio MD; Verd, Sergio MD

Section Editor(s): Forsythe, Paula L.

doi: 10.1097/ANC.0000000000000387
Outcomes of Neonatal Care

Background: Previous research has reported that infants fed donor milk grow slower than those fed formula. However, most of the trials used unfortified donor milk, which limits the ability to generalize the results to current clinical practice.

Purpose: To evaluate the impact of early human milk feeding (donor milk and/or mother's own milk) with standard fortification on in-hospital growth of very low-birth-weight infants.

Methods: This pre-/postretrospective study included selected newborn infants less than 1500 g admitted to a level IV neonatal intensive care unit before and after the introduction of a policy providing donor milk when mother's own milk was not available in sufficient quantity to meet her infant's need. When enteral feeds reached 80 mL/kg per day, all human milk was fortified.

Results: Seventy-two “before” (any formula-fed) and 114 “after” (human milk-fed) infants were enrolled in this study. Infant characteristics and neonatal morbidity were similar in both groups. Outcomes revealed that an initial human milk diet with standard fortification was associated with significantly higher early extrauterine weight gain and head growth in very low-birth-weight infants than a formula-fed diet.

Implications for Practice: Very early initiation of fortified breast and/or donor milk feeding can help promote in-hospital head growth and weight gain of preterm infants. Formula may not be appropriate for early use among preterm infants.

Implications for Research: Further large-scale clinical trials are needed to determine the best initiation and composition of enteral feeding for preterm infants.

Departments of Paediatrics (Dr Ginovart) and Clinical Epidemiology (Dr Gich), Hospital de la Santa Creu I Sant Pau, Barcelona, Spain; Division of Hematology, Molecular Biology Unit, Hospital Son Espases, Palma de Mallorca, Spain (Dr Gutiérrez); and Department of Primary Care, Balearic Health Authority, Health Sciences Research Institute IUNICS, Palma de Mallorca, Spain (Dr Verd).

Correspondence: Sergio Verd, MD, Department of Primary Care, Balearic Health Authority, Health Sciences Research Institute IUNICS, 10 Alexandre Rossello Ave, 07002 Palma de Mallorca, Spain (

Institution where the work occurred: Neonatal Unit, Department of Pediatrics, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.

The authors have no relevant financial relationships with any commercial interests.

The authors declare that they have no significant competing professional or personal interests that might have influenced the performance or presentation of the work described in this article.

© 2017 by The National Association of Neonatal Nurses