Resident Yale New Haven Children's Hospital Yale New Haven Hospital New Haven, Connecticut, United States
Background: In-hospital very preterm infant (VPI) nutrition and growth has been well-studied, yet less is known about growth in the months post-hospital discharge (HD) especially for the infant receiving mother’s milk (MM). Human milk fortifier post-hospital discharge is associated with increased weight gain, but only one study has evaluated 12-15-month growth outcomes with the more common practice of MM supplemented with transitional formula (TF).
Objective: To determine early post-HD weight gain of VPI receiving MM and how this relates to VPI receiving TF only.
Design/Methods: In this retrospective cohort study of VPI [≤ 32 weeks’ birth gestational age (GA)] born 7/2017 to 6/2019 and discharged to home prior to 52 weeks’ GA at one Northeast U.S. level IV NICU, data was collected by the Joint Data Analytics Team from the inpatient and outpatient medical record of a large hospital system. VPI HD intake was defined as the intake received on day preceding and day of HD. From weight measures [birth, HD, and last post-HD weight obtained at 55-182 days corrected age(CA)], z-scores were calculated from the Fenton (prior to 40 weeks’ GA) or WHO growth standards. Variables were compared by Chi-square and Mann Whitney tests.
Results: Of 197 subjects, 46% received MM supplemented with TF at HD. Of MM-fed infants, 81% were fed directly at breast any time during hospitalization and 35% were directly breastfed at HD. Compared to infants with TF only, MM-fed infants were less likely to be Black, more mature at birth with higher median weight and were less mature at HD with lower median weight (Table 1). However, the weight z-score at birth and HD did not differ between groups. The groups also were similar in caloric density of feeds and post-HD readmissions. Of the 65% VPI with post-HD weight measure at 55-182 CA, MM-fed VPI still were less likely to be Black and demonstrated lower birth gestational age and weight z-score, but no differences in HD weight z-score (Table 2). Both VPI groups experienced a median fall in z-score from birth to HD and a median increase from HD, but 11.6% VPI exhibited weight z-score 2 standard deviations below their birth z-score at the 55-182 days CA post-HD visit. Conclusion(s): In this cohort, VPI receiving MM supplemented with TF post-HD had a change in weight z-score similar to infants receiving TF only. With similar caloric density, VPI appear to gain weight as well on MM as those on TF.
Table 1. Demographics and weight gain characteristics of very preterm infants fed mother’s milk supplemented with transitional formula compared to those fed only transitional formula at hospital discharge
Table 2. Demographics and weight gain characteristics of very preterm infants with weight measure at 55-182 days corrected age who were fed mother’s milk supplemented with transitional formula compared to very preterm infants fed only transitional formula at hospital discharge
Authors/Institutions: Chelsea E. Hartman, Yale New Haven Hospital, New Haven, Connecticut, United States; Sarah Taylor, Yale University School of Medicine, New Haven, Connecticut, United States