Extremely low birth weight infants face a high risk of postnatal growth failure, which can impact long-term development. Fortifying human milk is a standard practice, but the best strategy for supporting optimal growth remains unclear. A French cohort study investigated the effects of combining standardized and individually adjusted fortification of human milk on growth and body composition. The study included 310 infants born weighing less than 1,000 grams. The findings suggest that this tailored nutritional approach reduced growth failure, particularly for body weight and head circumference, and supported healthy fat mass development.

Providing adequate nutrition to support growth in very small preterm infants remains a challenge in neonatal care. Many of these infants experience growth delays after birth, which have been linked to long-term concerns such as neurodevelopmental and kidney issues. Fortifying human milk can help but results often vary depending on how the fortification is done.

To explore a more effective approach, researchers observed a group of infants who received a two-phase fortification strategy: first, a standardized mix of nutrients was added to human milk, and later, individual adjustments were made based on each infant’s growth and blood test results. The goal was to better meet nutritional needs and improve outcomes by adapting care to each child’s progress.

Targeted Nutrition Shows Promising Results for Weight and Head Growth

The study found that the infants gained weight during their hospital stay, with only a slight slowdown compared to expected growth for infants of the same age, and their head growth was well maintained. Only 27% of the infants had signs of postnatal growth failure at discharge, which is notably lower than in many past reports. Meanwhile, 80% showed length growth delays, but this is consistent with what has been found in other studies. Importantly, the infants in this study had higher fat mass levels than fetuses of the same gestational age, suggesting a possible adaptation to life outside the womb.

Body composition was measured in about one-third of the infants. Those who grew well had more fat mass than those with growth delays, and a higher proportion of preterm formula in the diet appeared to help reduce growth failure. Earlier gestational age and the use of postnatal steroids were linked to greater risk of poor growth.

An Approach That Adapts to Individual Needs

For parents and care providers, these findings show that an individualized nutritional plan using fortified human milk can improve growth outcomes in extremely low birth weight infants. While length growth remains a challenge, maintaining good weight gain and head growth are promising signs for better long-term development.

Further research is still needed, but this study offers strong support for adapting nutrition based on each infant’s unique needs. It also highlights how careful monitoring of growth and nutrition can make a real difference during a critical stage of life.

Paper available at: Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study | European Journal of Pediatrics

Full list of authors: Perrin, T.; Pradat, P.; Larcade, J.; Masclef-Imbert, M.; Pastor-Diez, B.; Picaud, J.C.

DOI: https://doi.org/10.1007/s00431-022-04775-3