Association between nonacidified standard and high‐protein human milk fortifiers and increased weight velocity relative to acidified human milk fortifiers in preterm infants - A retrospective cohort study

Q: What was the study designed to evaluate regarding human milk fortifiers in preterm infants?

The study evaluated how acidified versus nonacidified human milk fortifiers, including standard- and high-protein combinations, affect growth velocity in preterm infants.

Q: How were the infants grouped in this retrospective cohort study?

Infants were compared across two groups: those receiving an acidified human milk fortifier and those receiving standard-protein plus high-protein human milk fortifiers.

Q: Which growth outcomes differed between fortifier groups, and at what time points?

Infants in the standard-protein/high-protein group had higher weight velocity at day 28 and 36 weeks’ postmenstrual age, and length velocity was higher at day 28 but not at 36 weeks’ postmenstrual age.

Sep 29, 2026

Uploaded by Asher

Fortification of human milk supports preterm infant growth, yet the growth impact of acidified versus nonacidified fortifiers remains clinically relevant. This retrospective, single-center study evaluated 375 preterm infants in a tertiary NICU receiving either an acidified human milk fortifier or a combination of standard- and high-protein nonacidified fortifiers. Primary outcomes were weight velocity at day 28 and 36 weeks’ postmenstrual age, analyzed with multivariable linear regression. Standard/high-protein fortifiers improved weight velocity and length velocity at day 28, with similar human milk exposure and comorbidity incidence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Methods

DOI: 10.1002/jpen.70026 ORI G INA L RESEARCH Association between nonacidified standard and high‐protein human milk fortifiers and increased weight velocity relative to acidified human milk fortifiers in preterm infants: A retrospective cohort study Arjun N. Bhatt BS1 | Rhyan Bingham DO1 | Philippe Gaillard PhD2 | Brian K. Stansfield MD1 1Department of Pediatrics, Division of Neonatology, Children's Hospital of Georgia, Augusta, Georgia, USA 2Department of Biostatistics, Data Science, and Epidemiology, Augusta University, Augusta, Georgia, USA *Correspondence Brian K. Stansfield, MD, Department of Pediatrics, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA. Email: [bstansfield@augusta.edu](bstansfield@augusta.edu) This and other JPEN podcasts are available at [https://nutritioncare.org/podcasts](https://nutritioncare.org/podcasts) Funding information Mead Johnson Nutrition Abstract Background: Fortification of human milk is necessary for preterm infant growth. We evaluated the impact of an acidified human milk fortifier and nonacidified human milk fortifiers on growth velocity in preterm infants. Methods: This retrospective, single‐center study compared preterm infants (N =375) receiving either acidified human milk fortifier (n = 163) or a combination of standard‐ protein and high‐protein human milk fortifier (n = 212) in a tertiary neonatal intensive care unit. Infants with a birth weight of 500–1800 g and feeding initiation by day of life 7 were eligible for inclusion. The coprimary outcome was weight velocity (g/kg/day) at day of life 28 and 36 weeks' postmenstrual age. Multivariable linear regression model for the coprimary outcomes and growth‐related secondary outcomes were adjusted for gestational age, birth weight, sex, and race. Results: Infants receiving standard‐protein/high‐protein human milk fortifiers demonstrated higher weight velocity at day of life 28 (12.09± 3.27 vs 10.92 ±3.06g/kg/day, P < 0.001) and 36 weeks' postmenstrual age (13.31 ±2.23 vs 12.67 ±2.28g/kg/day, P = 0.02) compared with those receiving acidified human milk fortifier. Length velocity at day of life 28 was greater in the standard‐protein/high‐protein group (1.09 ±0.54 vs 0.97 ±0.43 cm/week, P= 0.02) but not at 36 weeks' postmenstrual age (P=0.06). Human milk exposure and incidence of comorbidities were similar between groups. Conclusions: Standard‐ and high‐protein human milk fortifiers were associated with improved weight and length growth in preterm infants. KEYWO R DS enteral nutrition, neonates, nutrition assessment This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2025 The Author(s) . Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition. INTRODUCTION Human milk is the preferred nutrition for preterm infants.1–3 Preterm infants who receive human milk experience lower rates of necrotizing enterocolitis and bronchopulmonary dysplasia4,5 in the short term and improved neurodevelopmental outcomes and academic performance later in life.6,7 However, human milk alone contains insufficient quantities of key nutrients to meet the nutrition needs of preterm infants, and supplementation with a multinutrient fortifier is necessary to avoid slow postnatal growth.8–11 The evolution of multinutrient human milk fortifiers has addressed critical gaps in meeting the nutrition needs of preterm infants. The first human milk fortifiers were available as powders and acidified liquid formulations derived from bovine milk, but concerns were raised regarding the sterility of powder formulations and the association of metabolic acidosis with acidified human milk fortifiers.12–15 Nonacidi

FAQs

What was the study designed to evaluate regarding human milk fortifiers in preterm infants?

The study evaluated how acidified versus nonacidified human milk fortifiers, including standard- and high-protein combinations, affect growth velocity in preterm infants.

How were the infants grouped in this retrospective cohort study?

Infants were compared across two groups: those receiving an acidified human milk fortifier and those receiving standard-protein plus high-protein human milk fortifiers.

Which growth outcomes differed between fortifier groups, and at what time points?

Infants in the standard-protein/high-protein group had higher weight velocity at day 28 and 36 weeks’ postmenstrual age, and length velocity was higher at day 28 but not at 36 weeks’ postmenstrual age.

Sep 29, 2026

Uploaded by Asher