Fat supplementation of human milk for promoting growth in preterm infants

Human breast milk provides good nutrition for term infants for growth and has benefits for immunity and maternal-infant bonding. It may, however, contain insufficient quantities of some nutrients and calories to meet the needs for adequate growth of an infant born prematurely unless fed in large volumes. Fats provide approximately half of the calories in human milk and the milk contains components (bile-salt stimulated lipase) that help digest the fat. The fat component in some commercial human milk fortifiers is often in very low quantities because of concerns that preterm infants will deposit fat tissue to a greater extent than when in the uterus. They also have relatively poor digestion and absorption of fat with their immature digestive systems. Supplementing with medium-chain triglycerides (MCT), which are more easily digested than long-chain fats, may provide a ready source of energy for preterm infants for growth and neuronal development. The review authors searched the medical literature and found only one small randomised controlled trial (14 infants) investigating the effectiveness of human milk fat supplements with vitamins and minerals (calcium and phosphate). Growth was similar with and without fat supplement over the short study period. One infant in the fat supplement group developed feeding intolerance and there were no reports of damaging inflammation of the gut (necrotizing
enterocolitis).

Authors' conclusions: 

There is insufficient evidence to make recommendations for practice. Further research should evaluate the practice of supplementation of human milk with fat. This may best be done in the context of the development of multicomponent fortifiers. Both short term growth outcomes and long term growth and neurodevelopmental outcomes should be evaluated. Adverse effects should be evaluated.

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Background: 

For term infants, human milk provides adequate nutrition to facilitate growth, as well as potential beneficial effects on immunity and the maternal-infant emotional state. However, the role of human milk in premature infants is less well defined as it contains insufficient quantities of some nutrients to meet the estimated needs of the infant. There are potential short term and long term benefits from human milk, although observational studies have suggested that infants fed formula have a higher rate of growth than infants who are breast fed.

Objectives: 

The main objective is to determine if addition of supplemental fat to human milk leads to improved growth and neurodevelopmental outcomes without significant adverse effects in preterm infants.

Search strategy: 

The standard search strategy of the Cochrane Neonatal Collaborative Review Group was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE (1966-Apr 2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language.

Selection criteria: 

All trials utilizing random or quasi-random allocation to supplementation of human milk with fat or no supplementation in preterm infants within a hospital were eligible.

Data collection and analysis: 

Data were extracted using the standard methods of the Cochrane Neonatal Collaborative Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference.

Main results: 

Results are available for only one small study evaluating the effects of fat supplementation. There are insufficient data to evaluate short term or long term growth outcomes and neurodevelopmental outcomes. There are insufficient data to comment on potential adverse effects.

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