Optimising the protein and energy content of human milk feeds to improve the growth of preterm infants - A Randomised Control Trial (RCT)

Intervention: Fortifying human milk based on the macronutrient composition of milk, measured using mid-infrared technology. Milk is fortified using human milk fortifier (HMF), a whey protein supplement and a carbohydrate and fat (energy) supplement. The amount of fortifier added to milk feeds depends on the macronutrient composition of the milk and targets recommended protein and energy intakes (Tsang et al. 2005). The intervention is administered throughout the period of time an infant receives fortified feeds. Fortified milk feeds commence at the discretion of the neonatologist, according to the Unit's standard enteral feeding practice, and continue until discharge, unless clinically contraindicated. Standard enteral feeding practice incorporates 3 stages and two levels of feeds: Stage 1. Unfortified milk is fed until infants tolerate between 100 and 150 mL/kg/d. Stage 2. Milk is fortified to Level 1 - this level targets recommended protein and energy intakes within volumes of 160-180 mL/kg/d. Stage 3. (only for fluid restricted infants who are tolerating Level 1, who receive less than or equal to 150 mL/kg/d and who demonstrate poor growth). Milk is fortified to Level 2 - this level targets recommended protein and energy intakes within volumes of 130-150 mL/kg/d. REFERENCE Tsang RC, Uauy R, Koletzko B, Zlotkin SH (eds). Nutrition of the preterm infant. Scientific basis and practical guidelines. 2nd Ed. Cincinnati, Ohio: Digital Educational Publishing.