Grant: Operating Grant

Survival of preterm infants <32weeks of gestation has improved dramatically, however many grow poorly after birth. Inadequate nutrition in early life is a major factor in the restricted growth of these infants, which can lead to problems in brain development and increase the risk of chronic diseases in later life. Breast milk (BM) is recommended as the best source of nutrition for preterm infants, to which powdered fortifiers containing protein, minerals and energy are added to provide additional nutrients. The nutrient content of BM varies between mothers as well as between lactations of the same mother. Currently powdered fortifiers are added to BM in standard amounts and even with the addition of fortifier, the BM feeding may have a nutrient content below the recommended minimum amount for optimal growth. In a recent pilot study we demonstrated that the addition of fat, carbohydrate and protein can be individually adjusted to optimal levels with positive benefits for growth. The proposed research will investigate individualized fortification (IFO) of BM based on daily analysis of the BM's fat, protein and carbohydrate content in a randomized double blind controlled trial. IFO as well as a commercial fortifier will ensure that BM contains the target amounts of nutrient. Growth and development of infants receiving IFO will be compared with that of infants fed mother's BM that has been supplemented only with the standard amount of current routine fortifier. Postnatal growth of the infants will be assessed by measuring weight, length and head circumference as well as fat and lean mass using highly accurate, non-invasive methods throughout the intervention period and at the first follow-up visit at 3 months corrected age. Neurological development and fat and lean mass will be analyzed at age 18 months. We expect that IFO will improve the nutritional intake of preterm infants, optimize growth, and thus positively impact neurodevelopment and health.