Human Milk Fortifier After NICU Discharge Improves Human Milk Usage Rates for Preterm Infants.

BACKGROUND: A common neonatal intensive care unit (NICU) discharge feeding strategy for preterm infants with growth failure who are feeding exclusively expressed human milk (EHM) has been to enrich mother's own milk (MOM) with formula powder or supplement 2-3 feeds per day with formula. However, this strategy displaces human milk from the diet. Our NICU recently adopted the standard practice of adding commercial human milk fortifier (HMF) to human milk feedings after discharge. We compared breastfeeding rates and growth using these two strategies.

METHODS: Preterm infants (< 34 weeks gestation at birth) exclusively feeding EHM fortified with HMF at 2 weeks prior to discharge were included in this retrospective study. The "HMF" group (n=92) continued fortifying with HMF at home, while the historical comparison group (n=35) received our previous guidance to enrich or supplement using post-discharge formula.

RESULTS: Rates of human milk exclusivity after discharge decreased significantly less in the HMF group than the historical comparison group (to 83% vs 39% at the first outpatient visit and 27% vs 6%, respectively, at the second outpatient visit). Rates of any EHM feedings were also significantly higher in the HMF group. Fenton Z-scores for weight, length, and head circumference were not significantly different between the groups.

CONCLUSIONS: Continuing EHM fortification with HMF after NICU discharge, rather than enriching or supplementing with post-discharge infant formula, increases rates of feeding EHM for at least 3 months but does not affect growth.