Does human milk accelerate early enteral feeding advancement in VLBW infants

Background: Human milk (HM) is believed to improve feeding tolerance in very low birth weight VLBW infants compared to formula feeding thereby accelerating early enteral feeding advancement.

Objective: Aim of the present secondary analysis of a controlled randomized trial was to investigated whether human milk accelerates early enteral feeding advancement compared to formula feeding.

Methods: In 129 VLBW infants non-pasteurized HM was fed whenever available and fortification was started after 100ml/kg/day had been achieved. Early enteral feeding advancement was performed following a strict feeding protocol. If HM was not available, hydrolyzed protein or standard protein formula were fed. The hypothesis was tested (Mann-Whitney test) that infants who received >10% of HM achieved full feeds faster than infants for whom HM was not available (<10%). Multiple regression backward selection analysis was performed to analyze the effect of the available HM volume measured as percentage of total feeding volume on the time to achieve full feeds. Other variables whose effects were analyzed in the model were birth weight, gestational age, age at starting milk feeds, type of formula, prenatal Betametason treatment, umbilical artery ph, and Apgar scores. Data is shown as median (p25-p75).

Results: 42 Infants received >10% of HM (75%(37–96%)) and 87 infants <10% HM (0% (0–0%)). HM infants were significantly more mature (gestational age 29.4 (27.1–31.0) vs. 27.0 (25.2–29.3) weeks; p=0.012; >10%HM vs. <10%HM respectively), but there was no significant difference with regard to birth weight (980 (740–1280)g vs. 870 (695–1190)g; p=0.40), first day of milk feeding (day 3 (2–4) vs. 3 (2–5); p=0.96), and the age at full feeds (day 14 (12–21) vs. 15 (12–24); p=0.37). Multiple linear regression analysis confirmed this result since HM (p=0.82) was not associated with the time to achieve full feeds, in opposition to birth weight (p<0.001), type of formula (p<0.011), age at starting milk feds (p<0.001) and prenatal Betametason treatment (p=0.03).

Conclusion: The data did not support the claim that human milk increases early enteral feeding tolerance. Randomized trials in VLBW infants are required to analyze hypothesized beneficial effects of properly fortified human milk.