376 - A Comparison of Outcomes in Human Milk-Fed Premature Infants with a Human Milk-Derived Fortifier versus Bovine Milk-Derived Fortifier

Publication Number: 3363.376

Heerali Patel, Baylor College of Medicine, Houston, TX, United States; Peace Adeyemo, Baylor College of Medicine, Houston, TX, United States; Bharthi Mohan, Baylor College of Medicine, Boston, MA, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Leonor A. Massieu, Texas Children's Hospital, Houston, TX, United States; Laura Gollins, Texas Children's Hospital, Houston, TX, United States; Caraciolo Fernandes, Baylor College of Medicine, Houston, TX, United States; Catherine M. Gannon, Baylor College of Medicine/Ben Taub Hospital, Houston, TX, United States; Joseph Garcia-Prats, Baylor College of Medicine, Houston, TX, United States; Amy B. Hair, Baylor College of Medicine, Houston, TX, United States; Kanekal Gautham, UTHealth Houston, Houston, TX, United States; Muralidhar H. Premkumar, Baylor College of Medicine, Houston, TX, United States

Background: Human milk (mother’s own or donor) reduces necrotizing enterocolitis (NEC) risk, but fortification is needed to support growth. Fortifiers may be bovine milk–derived (BMDF) or human milk–derived (HMDF), with limited evidence on which provides better outcomes.

Objective: To evaluate short-term outcomes in human milk-fed infants with birth weight (BW) ≤1250 g receiving HMDF versus BMDF.

Design/Methods: At our division, Hospital A (Hosp A) uses HMDF, while Hospital B (Hosp B) uses BMDF, under otherwise similar feeding protocols. In this IRB-approved study, we retrospectively compared outcomes in human milk–fed infants with BW ≤1250 g born at Hosp A (HMDF) and Hosp B (BMDF) from 2020–23. Primary outcome was feed intolerance (feed interruption ≥12 hours or feed reduction >50%). Secondary outcomes included NEC, nutritional status, morbidities, and mortality. Quantitative and categorical variables were compared using the Wilcoxon rank-sum and Fisher’s exact tests, respectively. Outcomes with significant unadjusted differences were further analyzed using multiple linear regression, adjusting for imbalanced baseline characteristics.

Results: Among 418 included infants [356 from Hosp A (HMDF) and 62 from Hosp B (BMDF)], HMDF infants were more often Black, less often Hispanic, had higher 5-minute Apgars, lower birth weight, smaller head circumference, and more frequent prolonged rupture of membranes (Table 1). Feeding intolerance, frequency of NEC stage ≥2, surgical NEC, other morbidities, and mortality were not significantly different between the groups (Table 2). In unadjusted comparisons, HMDF had longer central line days and hospital stay. BMDF had a longer duration of fortification. At hospital discharge, HMDF-fed infants had higher postmenstrual age, greater length (cm), and greater formula use. After adjusting for significant differences in baseline characteristics, the predicted duration of central line in HMDF was 12.8 days longer (p=0.005) (Table 3).

Conclusion(s): In this retrospective study of human milk-fed infants ≤1250 g no differences were seen between HMDF and BMDF groups in feed intolerance, NEC, or other morbidities, but HMDF use was linked to longer predicted central line days. Given baseline differences, confounding is likely. Efforts are underway to obtain and adjust for severity of illness and proportion of mother’s own milk. These findings underscore the need for a large randomized controlled trial comparing HMDF and BMDF in human milk–fed infants.

Maternal and Infant Baseline Characteristics
PAS 2026 Fortifier Study Abstract Table 1.jpeg1. Frequency (percentage), Fisher’s exact test p-value
2. Median (interquartile range), Wilcoxon rank sum test p-value

Unadjusted Comparisons of Infant Outcomes
PAS 2026 Fortifier Study Abstract Table 2.jpeg1. Frequency (percentage), Fisher’s exact test p-value
2. Median (interquartile range), Wilcoxon rank sum test p-value

Multivariable comparison of outcomes after adjusting for significant differences in baseline characteristics*
PAS 2026 Fortifier Study Abstract Table 3.jpeg*Adjusted for race, ethnicity, PROM, FOC at birth, birth weight and 5-minute Apgar score