Effect of human milk fortification at different volume of feeds in pre-term newborns (< 32 weeks of gestation).

Abstract

Objective: To assess how feeding volume of `human milk fortification (HMF) influences growth and bone mineral status in preterm infants. Study Design: Parallel-arm, Randomized Controlled Trial. Setting: Department of Neonatology, RTEH Indus Hospital, Muzaffargarh, Pakistan. Period: September 2024 to June 2025. Methods: A total of 132 preterm newborns born before 32 weeks of gestation, with Apgar scores below 7 at five minutes, admitted to the NICU within 24 hours and exclusively fed maternal human milk were enrolled. Infants were randomized into early (70–100 ml/kg/day), middle (101–130 ml/kg/day), or late (130–160 ml/kg/day) HMF initiation groups. Growth parameters, bone mineral status (BMS), and complications were recorded at 36 weeks post-menstrual age (PMA). Data were analyzed using ANOVA and chi-square tests, with statistical significance set at p<0.05. Results: Among a total of 132 preterm infants, 66 (50.0%) were male, and the mean gestational age was 30.1±1.1 weeks. At 36 weeks PMA, the early HMF group showed significantly greater weight gain (1021.8±156.3 g) and linear growth (3.7±0.8 cm), with higher head circumference increase (3.3±0.7 cm), compared to the late HMF group (p<0.001). Early HMF was associated with lower alkaline phosphatase (309.2±61.6 IU/L) and higher calcium and phosphorus levels. Conclusion: The early initiation of HMF at lower enteral feeding volumes in preterm infants is associated with improved growth and BMS at 36 weeks PMA.