The debate over the effects of an exclusive human milk diet (EHMD) on postnatal growth among very preterm infants remains contentious. This retrospective multicenter study aims to elucidate the association between EHMD and short-term growth outcomes in infants born at less than 32 weeks of gestation. The primary focus is on comparing growth trajectories, including weight, length, and head circumference, between infants receiving EHMD and those not receiving it up to 34 weeks postmenstrual age. Sensitivity and subgroup analyses were conducted to further explore these associations.
Methods:
The study analyzed data from multiple centers retrospectively, comparing growth outcomes between infants receiving EHMD and those not receiving it, with a gestational age of less than 32 weeks. Primary outcomes included weight, length, and head circumference growth trajectories from birth to 34 weeks postmenstrual age. Sensitivity analyses and subgroup analyses were conducted to examine the robustness of the findings.
Results:
The study found that EHMD was independently associated with poorer length growth, particularly in infants born at 28 weeks of gestation or later, or those exposed to hypertensive disorders of pregnancy. However, initiating fortification at a caloric density of less than 26 kcal/oz on an EHMD was linked to inferior growth outcomes. Conversely, commencing fortification at a caloric density of 26 kcal/oz or higher on an EHMD was associated with improved weight growth, while maintaining similar length and head circumference growth compared to infants not receiving EHMD.
Conclusions:
The findings suggest that implementing an EHMD with initial fortification at a caloric density of 26 kcal/oz or higher could mitigate concerns regarding bovine milk exposure while sustaining comparable growth outcomes. This approach may offer a viable strategy to support the growth and development of very preterm infants without compromising nutritional integrity. Further research and clinical studies are warranted to validate these findings and inform evidence-based practices in neonatal care.
