Bovine colostrum as a fortifier to human milk in very preterm infants - A randomized controlled trial (FortiColos).

BACKGROUND: Human milk for very preterm infants need fortification for optimal growth and development but the optimal fortification product remains to be identified. AIMS: To investigate feasibility, safety and preliminary efficacy on growth and blood biochemistry when using intact bovine colostrum (BC) as a fortifier to human milk in very preterm infants. METHODS: In an open-label, multicenter, randomized controlled pilot trial (infants 26-31 weeks' gestation), mother's own milk or donor human milk was fortified with powdered BC (n = 115) or a conventional fortifier (CF, bovine-milk-based, n = 117) until 35 weeks' postmenstrual age. Fortifiers and additional micronutrients were added to human milk according to local guidelines to achieve optimal growth (additional protein up to +1.4 g protein/100 mL human milk). Anthropometry was recorded weekly. Clinical morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) were recorded. Clinical biochemistry included plasma amino acid (AA) levels to assess protein metabolic responses to the new fortifier. RESULTS: A total of 232 infants, gestational age (GA) 28.5 ± 1.4 (weeks + days), fulfilled inclusion criteria. Birthweight, GA and delta Z scores from birth to end of intervention on weight, length or head circumference did not differ between groups, nor between the subgroups of small for gestational age infants. Likewise, incidence of NEC (BC: 3/115 vs. CF: 5/117, p = 0.72, unadjusted values), LOS (BC: 23/113 vs. CF: 14/116, p = 0.08) and other morbidities did not differ. BC infants received more protein than CF infants (+10%, p < 0.05) and showed several elevated AA levels (+10-40%, p < 0.05). CONCLUSION: Infants fortified with BC showed similar growth but received more protein and showed a moderate increase in plasma AA-levels, compared with CF. Adjustments in protein composition and micronutrients in BC-based fortifiers may be required to fully suit the needs for very preterm infants.

Cranial ultrasound findings in preterm infants predict the development of cerebral palsy.

INTRODUCTION: Our aim was to evaluate any association between gestational age, birth weight and findings on cranial ultrasounds during hospitalisation in very preterm infants and mortality and neurological outcome in childhood. METHOD: This study was a retrospective cohort study based on a patient record review. The cohort consisted of very preterm born children (gestational age ≤ 32 + 0) born from 2004 to 2008. For each infant, we obtained results from all cranial ultrasounds performed during hospitalisation. In 2014, patient records were evaluated for cerebral palsy, Gross Motor Function Classification System, blindness and deafness. RESULTS: A total of 249 infants were included. The mortality rate was 9.2%. In all, 217 children were evaluated at 5-9 years of age. Four children were diagnosed with germinal matrix haemorrhage - intraventricular haemorrhage grade 3 (GMH-IVH3) and periventricular haemorrhagic infarction (PVHI), of whom two developed cerebral palsy. Nine children were diagnosed with periventricular leukomalacia (PVL), of whom six developed cerebral palsy. Cerebral palsy was detected in 14 children (6.4%), and one (0.5%) child was in need of a hearing assistive device. Severe brain injury (GMH-IVH3, PVHI or PVL) (p = 0.000) and being of male gender (p = 0.03) were associated with cerebral palsy in childhood. CONCLUSION: Severe brain injuries detected by neonatal cranial ultrasound in very preterm infants is associated with development of cerebral palsy in childhood. FUNDING: none. TRAIL REGISTRATION: not relevant.