Postnatal growth evaluation in preterm babies on expressed breast milk feeding admitted in NICU

This study is an observational analytical study with 3 cohorts of preterm neonates below 33 weeks of period of gestation who required neonatal intensive care unit (NICU) admission. The neonates in these three cohorts were provided expressed breast milk feeding in the following manner:-

a.       expressed breast milk going upto 200 ml/kg/day supplemented with Hind-milk

b.      expressed breast milk upto 150-160 ml/kg/day supplemented with liquid calcium phosphate  and liquid multivitamin-micronutrient

c.       expressed breast milk upto 150-160 ml/kg/day supplemented with multicomponent human milk fortifier powder

The goal of preterm nutrition is optimal postnatal growth and expressed breast milk feeding is unarguably the preferred form of milk. However it may not be able to provide the preterm with adequate protein, calcium, sodium, fats and other nutrients. Increasing total enteral intake, addition of hind-milk, fortification with human milk fortifier or supplementation by adding liquid calcium phosphate and multivitamin-micronutrient liquid are different strategies which are adopted with merits and demerits of each. The addition of multicomponent human milk fortifier powder has been shown to increase the risk of late onset sepsis and necrotizing enterocolitis in preterm neonates, while addition of liquid suspension of calcium phosphate results in milk fat chelation and reduced availability of milk fats and fat soluble vitamins and increased risk of feed intolerance. Enteral feeding upto 200 ml per kg per day is tolerated by preterm neonates and may produce optimal growth. Fortifying with hind-milk increases the availability of fats. This reduces the risk of late onset sepsis, NEC and feed intolerance and allows optimal postnatal growth.

This study is aimed as ascertaining the most suitable manner of enteral feeding in preterm neonates by using the primary outcome measure of mean weight gain (in gm per kg per day), mean increase in OFC (in cm per week) and mean increase in length (in cm per week). The secondary outcomes which would be studied are time to achieve and sustain full feeding for at least 5 successive days, time to regain birth weight, episodes of feed intolerance requiring interruption of feeds, necrotizing enterocolitis – all stages, late onset sepsis – probable and blood culture positive, duration of oxygen therapy and all-cause mortality.