(P18-020-23) The Impact of a Newly Formulated Human Milk Fortifier on Growth Velocity and Tolerance in Preterm Very Low Birthweight Infants

Objectives: To determine if a new non-acidified liquid human milk fortifier (NALHMF) provides comparable weight gain & growth patterns as an acidified liquid human milk fortifier (ALHMF) with similar/better tolerance and morbidity.

Methods: A retrospective comparison was conducted in 3 NICU’s. Eligibility criteria included gestational age (GA) < 32 weeks, birth weight (BW) < 1500 grams, exclusive breast milk feedings at start of fortification (mother’s own or donor), & enteral feeds > 80 ml/kg/d. Once formula was introduced, data was no longer collected. Demographic information, growth parameters, daily nutrition intake, serum chemistries, acid base status, & morbidity/mortality data were collected in deidentified forms. Comparison between groups were done using Wilcoxon Mann Whitney test for continuous variables due to non-normality. Chi-squared test used for categorical variables. Growth velocity calculated using the Exponential method. A p< 0.05 was considered significant.

Results: 539 infants enrolled. Median BW was 1075g & GA was 28+5 /7weeks for the NALHMF group vs 1100g & 29+1/7 weeks for the ALHMF group. Median age at start of feeds was 3 & 2.5 days of life for the NALHMF & ALHMF groups. Number of pre-fortification parenteral nutrition days for each was 6 days. Fortification started at a median postnatal age of 8 & 7 days for NALHMF & ALHMF groups. Donor milk used in 60% of infants receiving NALHMF & 63% of those receiving ALHMF. Over 90% & 60% of infants were receiving either fortifier at 2 & 4 weeks from the start of fortification. Growth velocity was higher in the NALHMF vs the ALHMF group after 2 & 4 weeks of fortification, 13.1 (8.5, 18.0) vs. 11.7 (5.6, 16.5) g/kg/d, median (IQR), p< 0.007, & 16.5 (14.5, 19.0) vs. 15.1 (12.3, 19.3) g/kg/d, median (IQR), p< 0.001. Intolerance (stopping feeds for >8hr) was uncommon (0-8%) & not different between groups. Proven late onset sepsis or confirmed NEC (stage 2 or higher) were uncommon & did not differ among groups (NALHMF= 8.7% versus ALHMF= 9.8%, & NALHMF= 4.7% vs ALHMF= 5.7%). Main demographics & length of stay comparable between groups. No differences in corrected GA or anthropometrics at discharge.

Conclusions: Awareness of new nutritional products is vital for clinicians that care for preterm infants. These data suggest that the new NALHMF is a suitable alternative to the ALHMF.

Funding Sources: Mead Johnson Nutrition/Reckitt