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. 2021 Jul;17(3):e13176.
doi: 10.1111/mcn.13176. Epub 2021 Mar 17.

The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses

Krysten North  1 , Megan Marx Delaney  2 , Carl Bose  1 , Anne C C Lee  3   4 , Linda Vesel  2 , Linda Adair  5 , Katherine Semrau  2   4
Affiliations

The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses

Krysten North et al. Matern Child Nutr. 2021 Jul.

Abstract

Approximately 15% of infants worldwide are born with low birthweight (<2500 g). These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in low-birthweight infants, with particular focus on low- and lower middle-income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty-six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high-income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother's milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500-2500 g in low- and lower middle-income countries.

Keywords: formula; fortification; growth; human milk; infant; low birthweight; umbrella review.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of selection of eligible reviews
FIGURE 2
FIGURE 2
Outcomes and quality of evidence for key meta‐analyses included in this umbrella review are grouped by type of intervention. The direction and significance of the weighted mean difference are indicated by the colour of the circle. The quality of the evidence is indicated by the size of the circle. See key for further detail. Abbreviations: CI, confidence interval; Circum, circumference; DHM, donor human milk; LA, linoleic acid; LC PUFA, long‐chain polyunsaturated fatty acids; MCT, medium‐chain triglycerides; MD, mean difference
FIGURE 3
FIGURE 3
Effect size and 95% confidence intervals of key meta‐analyses demonstrating the mean difference in weight gain, linear growth and head growth between feeding groups. Abbreviations: MD, mean difference; CI, confidence interval; g/kg/d, grams/kilogram/day; cm/wk, centimetres/week; DHM, donor human milk; HM, human milk; MCT, medium chain triglyceride
See this image and copyright information in PMC

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