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Meta-Analysis
. 2020 Nov 23;11(11):CD013465.
doi: 10.1002/14651858.CD013465.pub2.

Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk

Veronica Fabrizio  1   2 , Jennifer M Trzaski  1   2 , Elizabeth A Brownell  3   4 , Patricia Esposito  1 , Shabnam Lainwala  1   2 , Mary M Lussier  1 , James I Hagadorn  1   2
Affiliations
Meta-Analysis

Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk

Veronica Fabrizio et al. Cochrane Database Syst Rev. .

Abstract

Background: Human milk as compared to formula reduces morbidity in preterm infants but requires fortification to meet their nutritional needs and to reduce the risk of extrauterine growth failure. Standard fortification methods are not individualized to the infant and assume that breast milk is uniform in nutritional content. Strategies for individualizing fortification are available; however it is not known whether these are safe, or if they improve outcomes in preterm infants.

Objectives: To determine whether individualizing fortification of breast milk feeds in response to infant blood urea nitrogen (adjustable fortification) or to breast milk macronutrient content as measured with a milk analyzer (targeted fortification) reduces mortality and morbidity and promotes growth and development compared to standard, non-individualized fortification for preterm infants receiving human milk at < 37 weeks' gestation or at birth weight < 2500 grams.

Search methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on September 20, 2019. We also searched clinical trials databases and the reference lists of retrieved articles for pertinent randomized controlled trials (RCTs) and quasi-randomized trials.

Selection criteria: We considered randomized, quasi-randomized, and cluster-randomized controlled trials of preterm infants fed exclusively breast milk that compared a standard non-individualized fortification strategy to individualized fortification using a targeted or adjustable strategy. We considered studies that examined any use of fortification in eligible infants for a minimum duration of two weeks, initiated at any time during enteral feeding, and providing any regimen of human milk feeding.

Data collection and analysis: Data were collected using the standard methods of Cochrane Neonatal. Two review authors evaluated the quality of the studies and extracted data. We reported analyses of continuous data using mean differences (MDs), and dichotomous data using risk ratios (RRs). We used the GRADE approach to assess the certainty of evidence.

Main results: Data were extracted from seven RCTs, resulting in eight publications (521 total participants were enrolled among these studies), with duration of study interventions ranging from two to seven weeks. As compared to standard non-individualized fortification, individualized (targeted or adjustable) fortification of enteral feeds probably increased weight gain during the intervention (typical mean difference [MD] 1.88 g/kg/d, 95% confidence interval [CI] 1.26 to 2.50; 6 studies, 345 participants), may have increased length gain during the intervention (typical MD 0.43 mm/d, 95% CI 0.32 to 0.53; 5 studies, 242 participants), and may have increased head circumference gain during the intervention (typical MD 0.14 mm/d, 95% CI 0.06 to 0.23; 5 studies, 242 participants). Compared to standard non-individualized fortification, targeted fortification probably increased weight gain during the intervention (typical MD 1.87 g/kg/d, 95% CI 1.15 to 2.58; 4 studies, 269 participants) and may have increased length gain during the intervention (typical MD 0.45 mm/d, 95% CI 0.32 to 0.57; 3 studies, 166 participants). Adjustable fortification probably increased weight gain during the intervention (typical MD 2.86 g/kg/d, 95% CI 1.69 to 4.03; 3 studies, 96 participants), probably increased gain in length during the intervention (typical MD 0.54 mm/d, 95% CI 0.38 to 0.7; 3 studies, 96 participants), and increased gain in head circumference during the intervention (typical MD 0.36 mm/d, 95% CI 0.21 to 0.5; 3 studies, 96 participants). We are uncertain whether there are differences between individualized versus standard fortification strategies in the incidence of in-hospital mortality, bronchopulmonary dysplasia, necrotizing enterocolitis, culture-proven late-onset bacterial sepsis, retinopathy of prematurity, osteopenia, length of hospital stay, or post-hospital discharge growth. No study reported severe neurodevelopmental disability as an outcome. One study that was published after our literature search was completed is awaiting classification.

Authors' conclusions: We found moderate- to low-certainty evidence suggesting that individualized (either targeted or adjustable) fortification of enteral feeds in very low birth weight infants increases growth velocity of weight, length, and head circumference during the intervention compared with standard non-individualized fortification. Evidence showing important in-hospital and post-discharge clinical outcomes was sparse and of very low certainty, precluding inferences regarding safety or clinical benefits beyond short-term growth.

Trial registration: ClinicalTrials.gov NCT01487928 NCT01609894.

PubMed Disclaimer

Conflict of interest statement

VF on the Mothers' Milk Bank Northeast Advisory Board in a voluntary capacity. This is a non‐profit community milk bank that provides donated, pasteurized human milk. JMT has no interests to declare. EAB has no interests to declare. PE has no interests to declare. SL has no interests to declare. MML has no interests to declare. JIH has no interests to declare.

Core editorial and administrative support for this review has been provided by a grant from The Gerber Foundation. The Gerber Foundation is a separately endowed, private foundation, independent from the Gerber Products Company. The grantor has no input on the content of the review or the editorial process (see Sources of support).

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Targeted or adjustable vs standard, Outcome 1: Growth velocity, weight, g/kg/d, end of intervention
1.2
1.2. Analysis
Comparison 1: Targeted or adjustable vs standard, Outcome 2: Growth velocity, length, mm/d, end of intervention
1.3
1.3. Analysis
Comparison 1: Targeted or adjustable vs standard, Outcome 3: Growth velocity, head circumference, mm/d, end of intervention
1.4
1.4. Analysis
Comparison 1: Targeted or adjustable vs standard, Outcome 4: Bronchopulmonary dysplasia
1.5
1.5. Analysis
Comparison 1: Targeted or adjustable vs standard, Outcome 5: Retinopathy of prematurity, any
1.6
1.6. Analysis
Comparison 1: Targeted or adjustable vs standard, Outcome 6: Osteopenia
2.1
2.1. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 1: Growth velocity, weight, g/kg/d, end of intervention
2.2
2.2. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 2: Growth velocity, weight, g/kg/d, start of fortification to 40 weeks' PMA
2.3
2.3. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 3: Growth velocity, weight, g/kg/d, start of fortification to 3 months' CA
2.4
2.4. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 4: Growth velocity, weight, g/kg/d, start of fortification to 6 months' CA
2.5
2.5. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 5: Growth velocity, weight, g/kg/d, start of fortification to 12 months' CA
2.6
2.6. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 6: Growth velocity, length, mm/d, end of intervention
2.7
2.7. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 7: Growth velocity, length, mm/d, start of fortification to 40 weeks' PMA
2.8
2.8. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 8: Growth velocity, length, mm/d, start of fortification to 3 months' CA
2.9
2.9. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 9: Growth velocity, length, mm/d, start of fortification to 6 months' CA
2.10
2.10. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 10: Growth velocity, length, mm/d, start of fortification to 12 months' CA
2.11
2.11. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 11: Growth velocity, head circumference, mm/d, end of intervention
2.12
2.12. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 12: Growth velocity, head circumference, mm/d, start of fortification to 40 weeks' PMA
2.13
2.13. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 13: Growth velocity, head circumference, mm/d, start of fortification to 3 months' CA
2.14
2.14. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 14: Growth velocity, head circumference, mm/d, start of fortification to 6 months' CA
2.15
2.15. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 15: Growth velocity, head circumference, mm/d, start of fortification to 12 months' CA
2.16
2.16. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 16: Change in BMI, end of intervention
2.17
2.17. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 17: Change in BMI, start of fortification to 40 weeks' PMA
2.18
2.18. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 18: Change in BMI, start of fortification to 3 months' CA
2.19
2.19. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 19: Change in BMI, start of fortification to 6 months' CA
2.20
2.20. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 20: Change in BMI, start of fortification to 12 months' CA
2.21
2.21. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 21: Length of hospital stay, days
2.22
2.22. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 22: Postmenstrual age at discharge, weeks
2.23
2.23. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 23: In‐hospital mortality
2.24
2.24. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 24: Necrotizing enterocolitis
2.25
2.25. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 25: Culture‐proven late‐onset bacterial sepsis
2.26
2.26. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 26: Retinopathy of prematurity, any
2.27
2.27. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 27: Osteopenia
2.28
2.28. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 28: Bronchopulmonary dysplasia
2.29
2.29. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 29: BPD subgroup ‐ in‐hospital mortality
2.30
2.30. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 30: BPD subgroup ‐ length of hospital stay, days
2.31
2.31. Analysis
Comparison 2: Targeted vs standard fortification, Outcome 31: BPD subgroup ‐ postmenstrual age at discharge, weeks
3.1
3.1. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 1: Growth velocity, weight, g/kg/d, end of intervention
3.2
3.2. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 2: Growth velocity, length, mm/d, end of intervention
3.3
3.3. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 3: Growth velocity, head circumference, mm/d, end of intervention
3.4
3.4. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 4: Growth velocity, weight, g/d, end of intervention
3.5
3.5. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 5: Retinopathy of prematurity, any
3.6
3.6. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 6: Osteopenia
3.7
3.7. Analysis
Comparison 3: Adjustable vs standard fortification, Outcome 7: Bronchopulmonary dysplasia
4.1
4.1. Analysis
Comparison 4: Targeted vs adjustable fortification, Outcome 1: Growth velocity, weight, g/kg/d, end of intervention
4.2
4.2. Analysis
Comparison 4: Targeted vs adjustable fortification, Outcome 2: Growth velocity, length, mm/d, end of intervention
4.3
4.3. Analysis
Comparison 4: Targeted vs adjustable fortification, Outcome 3: Growth velocity, head circumference, mm/d, end of intervention
4.4
4.4. Analysis
Comparison 4: Targeted vs adjustable fortification, Outcome 4: Retinopathy of prematurity, any
4.5
4.5. Analysis
Comparison 4: Targeted vs adjustable fortification, Outcome 5: Osteopenia
4.6
4.6. Analysis
Comparison 4: Targeted vs adjustable fortification, Outcome 6: Bronchopulmonary dysplasia
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Agakidou 2019 {published and unpublished data}
    1. Agakidou E, Karagiozoglou-Lampoudi T, Parlapani E, Fletouris DJ, Sarafidis K, Tzimouli V, et al. Modifications of own mothers' milk fortification protocol affect early plasma IGF-I and ghrelin levels in preterm infants: a randomized clinical trial. Nutrients 2019;11(12):3056. [DOI: 10.3390/nu11123056] [PMID: ] - DOI - PMC - PubMed
Arslanoglu 2006 {published data only}
    1. Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: does it make a difference? Journal of Perinatology 2006;26(10):614-21. [DOI: 10.1038/sj.jp.7211571] [PMID: ] - DOI - PubMed
Bulut 2019 {published data only}
    1. Bulut O, Coban A, Uzunhan O, Ince Z. Effects of targeted versus adjustable protein fortification of breast milk on early growth in very low-birth-weight preterm infants: a randomized clinical trial. Nutrition in Clinical Practice 2020;35(2):335-43. [DOI: 10.1002/ncp.10307] [PMID: ] - DOI - PubMed
Hair 2014 {published data only}
    1. Hair AB, Bergner EM, Lee ML, Moreira AG, Hawthorne KM, Rechtman DJ, et al. Premature infants 750-1,250 g birth weight supplemented with a novel human milk-derived cream are discharged sooner. Breastfeeding Medicine 2016;11(3):133-7. [DOI: 10.1089/bfm.2015.0166] [PMID: 26982282] - DOI - PMC - PubMed
    1. Hair AB, Blanco CL, Moreira AG, Hawthorne KM, Lee ML, Rechtman DJ, et al. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. Journal of Pediatrics 2014;165(5):915-20. [DOI: 10.1016/j.jpeds.2014.07.005] [PMID: ] - DOI - PubMed
Kadioglu Simsek 2019 {published data only}
    1. Kadioglu Simsek G, Alyamac Dizdar E, Arayici S, Canpolat F, Sari F, Uras N, et al. Comparison of the effect of three different fortification methods on growth of very low birth weight infants. Breastfeeding Medicine 2019;14(1):63-8. [DOI: 10.1089/bfm.2018.0093Abstract] [PMID: ] - DOI - PubMed
Moro 1995 {published data only}
    1. Moro GE, Minoli I, Ostrom M, Jacobs JR, Picone TA, Raiha NC, et al. Fortification of human milk: evaluation of a novel fortification scheme and of a new fortifier. Journal of Pediatric Gastroenterology and Nutrition 1995;20(2):162-72. [DOI: 10.1097/00005176-199502000-00005] [PMID: ] - DOI - PubMed
Rochow 2020 {published data only (unpublished sought but not used)}
    1. Rochow N, Fusch G, Ali A, Bhatia A, So HY, Iskander R, et al. Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: a double-blind randomized controlled trial. Clinical Nutrition 2020;S0261-5614(20):30303-8. [DOI: 10.1016/j.clnu.2020.04.031] [PMID: ] - DOI - PubMed

References to studies excluded from this review

Boehm 1993 {published data only}
    1. Boehm G, Borte M, Bellstedt K, Moro G, Minoli I. Protein quality of human milk fortifier in low birth weight infants: effects on growth and plasma amino acid profiles. Europena Journal of Pediatrics 1993;152(12):1036-9. [DOI: 10.1007/BF01957232] [PMID: ] - DOI - PubMed
Kanmaz 2013 {published data only}
    1. Kanmaz HG, Mutlu B, Canpolat FE, Erdeve O, Oguz SS, Uras N, et al. Human milk fortification with differing amounts of fortifier and its association with growth and metabolic responses in preterm infants. Journal of Human Lactation 2013;29(3):400-5. [DOI: 10.1177/0890334412459903] [PMID: ] - DOI - PubMed
Maas 2017 {published data only}
    1. Maas C, Mathes M, Bleeker C, Vek J, Bernhard W, Wiechers C, et al. Effect of increased enteral protein intake on growth in human milk-fed preterm infants: a randomized clinical trial. JAMA Pediatrics 2017;171(1):16-22. [DOI: 10.1001/jamapediatrics.2016.2681] [PMID: ] - DOI - PubMed
Mathes 2018 {published data only}
    1. Mathes M, Maas C, Bleeker C, Vek J, Bernhard W, Peter A, et al. Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at < 32 weeks gestation and < 1500 g birth weight enrolled in a randomized controlled trial - a secondary analysis. BioMed Central Pediatrics 2018;18(1):154. [DOI: 10.1186/s12887-018-1136-5] [PMID: ] - DOI - PMC - PubMed
McLeod 2016 {published data only}
    1. McLeod G, Sherriff J, Hartmann PE, Nathan E, Geddes D, Simmer K. Comparing different methods of human breast milk fortification using measured v. assumed macronutrient composition to target reference growth: a randomised controlled trial. British Journal of Nutrition 2016;115(3):431-9. [DOI: 10.1017/S0007114515004614] [PMID: ] - DOI - PubMed
Morlacchi 2016 {published data only}
    1. Morlacchi L, Mallardi D, Gianni ML, Roggero P, Amato O, Piemontese P, et al. Is targeted fortification of human breast milk an optimal nutrition strategy for preterm infants? An interventional study. Journal of Translational Medicine 2016;14(1):195. [DOI: 10.1186/s12967-016-0957-y] [PMID: ] - DOI - PMC - PubMed
Quan 2019 {published data only}
    1. Quan M, Wang D, Gou L, Sun Z, Ma J, Zhang L, et al. Individualized human milk fortification to improve the growth of hospitalized preterm infants. Nutrition in Clinical Practice 2019:Online ahead of print. [DOI: 10.1002/ncp.10366] [PMID: ] - DOI - PubMed

References to studies awaiting assessment

Brion 2020 {published data only}
    1. Brion LP, Rosenfeld CR, Heyne R, Brown LS, Lair CS, Petrosyan E, et al. Optimizing individual nutrition in preterm very low birth weight infants: double-blinded randomized controlled trial. Journal of Perinatology 2020;40(4):655-65. [DOI: 10.1038/s41372-020-0609-1] [PMID: ] - DOI - PubMed

Additional references

AAP 1977
    1. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics 1977;60(4):519-30. [PMID: ] - PubMed
AAP 2012
    1. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 2012;129(3):e827-41. [DOI: 10.1542/peds.2011-3552] [PMID: ] - DOI - PubMed
Adamkin 2014
    1. Adamkin DH, Radmacher PG. Fortification of human milk in very low birth weight infants (VLBW <1500 g birth weight). Clinics in Perinatology 2014;41(2):405-21. [DOI: 10.1016/j.clp.2014.02.010] [PMID: ] - DOI - PubMed
Agostoni 2010
    1. Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al, ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2010;50(1):85-91. [DOI: 10.1097/MPG.0b013e3181adaee0] [PMID: ] - DOI - PubMed
Alan 2013
    1. Alan S, Atasay B, Cakir U, Duran Y, Kilic A, Kahvecioglu D, et al. An intention to achieve better postnatal in-hospital growth for preterm infants: adjustable protein fortification of human milk. Early Human Development 2013;89(12):1017-23. [DOI: 10.1016/j.earlhumdev.2013.08.015] [PMID: ] - DOI - PubMed
Amissah 2018a
    1. Amissah EA, Brown J, Harding JE. Protein supplementation of human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews 2018, Issue 6. - PMC - PubMed
Amissah 2018b
    1. Amissah EA, Brown J, Harding JE. Carbohydrate supplementation of human milk to promote growth in preterm infants. Cochrane Database of Systematic Reviews 2018, Issue 8. - PMC - PubMed
Amissah 2018c
    1. Amissah EA, Brown J, Harding JE. Fat supplementation of human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews 2018, Issue 6. - PMC - PubMed
Arslanoglu 2019
    1. Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of human milk for preterm infants: update and recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Frontiers in Pediatrics March 2019;7:76. [DOI: 10.3389/fped.2019.00076] [PMID: 30968003] - DOI - PMC - PubMed
Bayley 1993
    1. Bayley N. Bayley Scales of Infant Development–II. San Antonio, Texas: Psychological Corporation, 1993.
Bayley 2005
    1. Bayley N. Bayley Scales of Infant and Toddler Development. 3rd edition. San Antonio, TX: Harcourt Assessment, 2005.
Bell 1978
    1. Bell M, Ternberg J, Feigin R, Keating J, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Annals of Surgery 1978;187(1):1-7. [DOI: 10.1097/00000658-197801000-00001] [PMID: ] - DOI - PMC - PubMed
Brown 2020
    1. Brown JV, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database of Systematic Reviews 2020, Issue 6. [DOI: 10.1002/14651858] - DOI - PMC - PubMed
Clark 2003
    1. Clark R, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003;111(5 Pt1):986-90. [DOI: 10.1542/peds.111.5.986] [PMID: ] - DOI - PubMed
Ehrenkranz 1999
    1. Ehrenkranz R, Younes N, Lemons J, Fanaroff A, Donovan E, Wright L, et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999;104(2 Pt 1):280-9. [DOI: 10.1542/peds.104.2.280] [PMID: ] - DOI - PubMed
Ehrenkranz 2006
    1. Ehrenkranz RA, Dusic AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117(4):1253-61. [DOI: 10.1542/peds.2005-1368] [PMID: ] - DOI - PubMed
Ehrenkranz 2014
    1. Ehrenkranz RA. Extrauterine growth restriction: is it preventable? Jornal de Pediatria 2014;90(1):1-3. [DOI: 10.1016/j.jped.2013.10.003] [PMID: ] - DOI - PubMed
Embleton 2001
    1. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2001;107(2):270-3. [DOI: 10.1542/peds.107.2.270] [PMID: ] - DOI - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed 05/25/2020. Hamilton (ON): McMaster University (developed by Evidence Prime). Available at gradepro.org.
Griffin 2016
    1. Griffin IJ, Tancredi DJ, Bertino E, Lee HC, Profit J. Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Archives of Disease in Childhood. Fetal and Neonatal Edition 2016;101(1):F50-5. [DOI: 10.1136/archdischild-2014-308095] [PMID: ] - DOI - PubMed
Higgins 2011a
    1. Higgins JP, Altman DG, Sterne JA, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group. Chapter 8. Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2011b
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2019
    1. Higgins JPT, Eldridge S, Li T. Chapter 23. Including variants on randomized trials, Section 23.3. Studies with more than two intervention groups. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (updated July 2019). Available from www.training.cochrane.org/handbook. Cochrane, 2019.
Horbar 2015
    1. Horbar JD, Ehrenkranz RA, Badger GJ, Edwards EM, Morrow KA, Soll RF, et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000-2013. Pediatrics 2015;136(1):e84-92. [DOI: 10.1542/peds.2015-0129] [PMID: ] - DOI - PubMed
Hu 2019
    1. Hu F, Tang Q, Wang Y, Wu J, Ruan H, Lu L, et al. Analysis of nutrition support in very low-birth-weight infants with extrauterine growth restriction. Nutrition in Clinical Practice 2019;34(3):436-43. [DOI: 10.1002/ncp.10210] [PMID: 30421458] - DOI - PMC - PubMed
Jobe 2001
    1. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. American Journal of Respiratory and Critical Care Medicine 2001;163(7):1723-9. [DOI: 10.1164/ajrccm.163.7.2011060] [PMID: ] - DOI - PubMed
Kohn 2020
    1. Kohn MA, Senyak J. Sample Size Calculators [website]. UCSF CTSI. 27 July 2020. Available at https://www.sample-size.net/ (accessed 19 August 2020).
Lawrence 2011
    1. Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Professional. 7th edition. St Louis, MO: Mosby (Elsevier), 2010.
Luo 2018
    1. Dehui L, Xiang W, Jiming L, Tiejun T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Statistical Methods in Medical Research 2018;27(6):1785–805. - PubMed
Median to Mean Calculator 2020
    1. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. http://www.math.hkbu.edu.hk/~tongt/papers/median2mean.html. (accessed 29 May 2020). - PMC - PubMed
Moore 2011
    1. Moore TA, Wilson ME. Feeding intolerance: a concept analysis. Advances in Neonatal Care 2011;11(3):149-54. [DOI: 10.1097/ANC.0b013e31821ba28e] [PMID: ] - DOI - PubMed
Ofek Shlomai 2014
    1. Ofek Shlomai N, Reichman B, Lerner-Geva L, Boyko V, VBar-Oz B. Population-based study shows improved postnatal growth in preterm very-low-birthweight infants between 1995 and 2010. Acta Paediatrica 2014;103(5):498-503. [DOI: 10.1111/apa.12569] [PMID: ] - DOI - PubMed
Patel 2005
    1. Patel AL, Engstrom JL, Meier PP, Kimura RE. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants. Pediatrics 2005;116(6):1466-73. [DOI: 10.1542/peds.2004-1699] [PMID: ] - DOI - PubMed
Premkumar 2019
    1. Premkumar MH, Pammi M, Suresh G. Human milk-derived fortifier versus bovine milk-derived fortifier for prevention of mortality and morbidity in preterm neonates. Cochrane Database of Systematic Reviews 2019, Issue 11. - PMC - PubMed
Radmacher 2013
    1. Radmacher PG, Lewis SL, Adamkin DH. Individualizing fortification of human milk using real time human milk analysis. Journal of Neonatal-Perinatal Medicine 2013;6(4):319-23. [DOI: 10.3233/NPM-1373113] [PMID: ] - DOI - PubMed
Radmacher 2017
    1. Radmacher PG, Adamkin DH. Fortification of human milk for preterm infants. Seminars in Fetal & Neonatal Medicine 2017;22(1):30-5. [DOI: 10.1016/j.siny.2016.08.004] [PMID: ] - PubMed
Review Manager 2014 [Computer program]
    1. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rochow 2013
    1. Rochow N, Fusch G, Choi A, Chessell L, Elliott L, McDonald K, et al. Target fortification of breast milk with fat, protein and carbohydrates for preterm infants. Journal of Pediatrics 2013;163(4):1001-7. [DOI: 10.1016/j.jpeds.2013.04.052] [PMID: ] - DOI - PubMed
Saarela 2005
    1. Saarela T, Kojjonen J, Koivisto M. Macronutrient and energy contents of human milk fractions during the first six months of life. Acta Paediatrica 2005;94(9):1176-81. [DOI: 10.1111/j.1651-2227.2005.tb02070.x] [PMID: ] - DOI - PubMed
Sammallahti 2014
    1. Sammallahti S, Pyhälä R, Lahti M, Lahti J, Pesonen AK, Heinonen K, et al. Infant growth after preterm birth and neurocognitive abilities in young adulthood. Journal of Pediatrics 2014;165(6):1109-15.e3. [DOI: 10.1016/j.jpeds.2014.08.028] [PMID: ] - PubMed
Sauer 2011
    1. Sauer CW, Kim JH. Human milk macronutrient analysis using point-of-care near infrared spectrophotometry. Journal of Perinatology 2011;31(5):339-43. [DOI: 10.1038/jp.2010.123] [PMID: ] - DOI - PubMed
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editors, Grade Working Group. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from gdt.guidelinedevelopment.org/app/handbook/handbook.html.
Thanigainathan 2020
    1. Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database of Systematic Reviews 2020, Issue 7. - PMC - PubMed
US Food and Drug Administration 2018
    1. US Food and Drug Administration. FDA permits marketing of a diagnostic test to aid in measuring nutrients in breast milk. US FDA website: online news article 2018. Retrieved 25 August 2019, from www.fda.gov/news-events/press-announcements/fda-permits-marketing-diagno....
Wake Forest/Baptist Medical Center 2018
    1. Wake Forest/Baptist Medical Center. Brenner Children's NICU is first in nation to use FDA-approved breast milk analyzer. Online news article 2018. Retrieved 25 August 2019 from newsroom.wakehealth.edu/News-Releases/2019/05/Brenner-Childrens-NICU-is-....
Wu 2018
    1. Wu X, Jackson RT, Khan SA, Ahuja J, Pehrsson PR. Human milk nutrient composition in the United States: current knowledge, challenges, and research needs. Current Developments in Nutrition 2018;2(7):nzy025. [DOI: 10.1093/cdn/nzy025] [PMID: ] - PMC - PubMed
Young 2013
    1. Young L, Embleton ND, McCormick FM, McGuire W. Multinutrient fortification of human breast milk for preterm infants following hospital discharge. Cochrane Database of Systematic Reviews 2013, Issue 2. - PMC - PubMed

References to other published versions of this review

Fabrizio 2019
    1. Fabrizio V, Trzaski JM, Brownell EA, Esposito P, Lainwala S, Lussier MM, et al. Targeted or adjustable versus standard diet fortification for growth and development in very low birth weight infants receiving human milk. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No: CD013465. [DOI: 10.1002/14651858.CD013465] - DOI - PMC - PubMed

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