A study of safety and effectiveness of amino-acids based multi-nutrient fortifier in preterm infants
DOI:
https://doi.org/10.18203/2349-3291.ijcp20240689Keywords:
AABF, Preterm, Fortification, Amino acidsAbstract
Background: Fortification plays a vital role in supporting the nutritional requirements in the premature infants. Currently in India, fortifiers are either whole protein based or whey protein which are bovine milk- based, which has been associated with increased risk of feed intolerance and necrotizing enterocolitis (NEC), to circumvent this, an amino-acids based fortifier has been made available which provides more proteins (0.35 g/1 g sachet) thereby meeting the nutritional requirements of preterm infants. Aim was to study effect (safety and efficacy) of fortification with the amino-acids based fortifier (HMF-ADVANCE, Analeptik Biologicals) in premature infants admitted in the neonatal intensive care unit (NICU).
Methods: A single centre pilot study was conducted on preterm infants with <1800 g birth weight and/or <32 gestational age, amino-acids based fortifier (AABF) was used as the fortification option once the infants reached 100 ml/kg/day feed volume. 1 g of HMF-ADVANCE was mixed in 25 ml of mother’s own milk (MOM) and the fortification was continued till discharge from NICU.
Results: A total 100 preterm infants were included for the study, mean gestational age (GA) was 29.38±1.61 weeks, mean birth weight was 1159.90±301.9. Growth outcomes at the end of the study: mean weight gain was 23.73±7.62 g/day, mean head circumference gain was 1.02±0.41 cm/week, mean length gain was 1.01±0.15 cm/week and weight gain velocity were 17.13±2.38 g/kg/day. Blood urea nitrogen (BUN) showed an increasing trend from baseline (before starting fortification: 3.2 mg/dl), 1 week after fortification (6.3 mg/dl) and at the end of study (11.2 mg/dl). AABF was also used in three neonates post NEC. There were no episodes of feed intolerance or necrotising enterocolitis episodes and none of neonates discontinued fortification till discharge from NICU.
Conclusions: AABF was well tolerated without any feed intolerance episodes and helped to achieve optimal growth. AABF can be the optimal choice of fortification in low-birth-weight neonates.
References
Breeze ACG, Lees CC. Prediction and perinatal outcomes of fetal growth restriction. Semin Fetal Neonatal Med. 2007;12:383-97.
Bernstein IM, Horbar JD, Badger GJ. Morbidity and mortality among very low birth weight neonates with intrauterine growth restriction. The Vermont Oxford Network. Am J Obstet Gynecol. 2000;182:198-206.
Neu J, Zhang L. Feeding intolerance in very-low-birth weight infants: what is it and what can we do about it? Acta Paediat. 2005;94:93-9.
Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O'Shea TM. Early human milk feed is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007;27:428-33.
Mihatsch WA, Hogel J, Pohlandt F. Hydrolized protein accelerates the gastro-intestinal transport of formula in preterm infants. Acta Paediatr. 2001;90:196-8.
MihatschWA, Franz AR, Hogel J, Pohlandt F. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Pediatrics. 2002;110:1199-203.
Raithel M, Winterkamp S, Weidenhiller M, Müller S, Hahn EG. Combination therapy using fexofenadine, disodium cromoglycate and hypoallergenic amino acid-based formula induced remission in a patient with steroid dependent, chronically active ulcerative colitis. Int J Colorectal Dis. 2007;22:833-9.
Johnson T, Macdonald S, Hill SM, Thomas A, Murphy MS. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut. 2006;55:356-61.
Dallas DC, Underwood MA, Zivkovic AM, German JB. Digestion of Protein in Premature and Term Infants. J Nutr Disord Ther. 2012;2(3):112.
Demers-Mathieu V, Qu Y, Underwood MA, Borghese R, Dallas DC. Premature Infants have Lower Gastric Digestion Capacity for Human Milk Proteins than Term Infants. J Pediatr Gastroenterol Nutr. 2018;66(5):816-21.
Weijzen MEG, van Gassel RJJ, Kouw IWK, Trommelen J, Gorissen SHM, van Kranenburg J, et al. Ingestion of Free Amino Acids Compared with an Equivalent Amount of Intact Protein Results in More Rapid Amino Acid Absorption and Greater Postprandial Plasma Amino Acid Availability Without Affecting Muscle Protein Synthesis Rates in Young Adults in a Double-Blind Randomized Trial. J Nutr. 2022;152(1):59-67.
Wang X, Sadeghirad B, Morgan RL, Zeratkaar D, Chang Y, Crandon HN, et al. Amino acids for the prevention of mortality and morbidity in preterm infants: a systematic review and network meta-analysis. Sci Rep. 2022;12(1):18333.
Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, et al. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr. 2023;76(2):248-68.
Tewari VV, Kumar A, Singhal A, Prakash A, Pillai N, Varghese J. Proportionate Postnatal Growth in Preterm Neonates on Expressed Breast Milk Feeding With Selected Fortification. Nutr Clin Pract. 2020;35(4):715-23.
Gartner LM, Morton J, Lawrence RA. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2005;115:496-106.
Moro GE, Arslanoglu S, Bertino E, Corvaglia L, Montirosso R, Picaud JC, et al. XII. Human milk in feeding premature infants. J Pediatr Gastroenterol Nutr. 2015;61(1):S16-9.
Raimondi F, Spera AM, Sellitto M, Landolfo F, Capasso L. Amino acid-based formula as a rescue strategy in feeding very-low-birth-weight infants with intrauterine growth restriction. J Pediatr Gastroenterol Nutr. 2012;54(5):608-12.
Premji SS, Fenton TR, Sauve RS. Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database Syst Rev. 2006;1:CD003959.
Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253-61.
Vanderveen DK, Martin CR, Mehendale R, Allred EN, Dammann O, Leviton A; ELGAN Study Investigators. Early nutrition and weight gain in preterm newborns and the risk of retinopathy of prematurity. PLoS One. 2013;8:e64325.
Kim JH, Chan G, Schanler R, Groh-Wargo S, Bloom B, Dimmit R, et al. Growth and Tolerance of Preterm Infants Fed a New Extensively Hydrolyzed Liquid Human Milk Fortifier [published correction appears in J Pediatr Gastroenterol Nutr. 2016;62(1):188-9.
Mukhopadhyay K, Narnag A, Mahajan R. Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies: a randomized controlled trial. Indian Pediatr. 2007;44(4):286-90.
