Comparative effectiveness of liquid human milk fortifiers: A systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of liquid human milk fortifiers (HMFs) derived from exclusive HM or hydrolyzed protein on growth, necrotizing enterocolitis (NEC), or late-onset sepsis in North American very low-birth-weight (VLBW) infants compared with powder HMFs (control). METHODS: Prospective trials published between 2009 and 2020 were systematically reviewed, and meta-analysis was conducted by using a random-effects model. RESULTS: Five studies were identified for up to 591 participants across 39 centers. Study treatments included whey or casein hydrolysate HMF and exclusive HM HMF. Infants fed whey or casein hydrolysate HMF had growth differences compared with the control. No differences were found across treatments in regard to NEC or sepsis. CONCLUSION: Very low-quality evidence suggests greater linear growth in VLBW infants fed whey hydrolysate liquid HMF, as well as greater weight gain in those fed casein hydrolysate HMF, compared with the control. Additional prospective, multicenter randomized controlled trials are needed to confirm these estimates because of sparsity of evidence. There is insufficient evidence to support HMF decisions regarding NEC or late-onset sepsis prophylaxis.

Evaluation of Key Factors Impacting Feeding Safety in the Neonatal Intensive Care Unit: A Systematic Review.

BACKGROUND: Individualized feeding care plans and safe handling of milk (human or formula) are critical in promoting growth, immune function, and neurodevelopment in the preterm infant. Feeding errors and disruptions or limitations to feeding processes in the neonatal intensive care unit (NICU) are associated with negative safety events. Feeding errors include contamination of milk and delivery of incorrect or expired milk and may result in adverse gastrointestinal illnesses. PURPOSE: The purpose of this review was to evaluate the effect(s) of centralized milk preparation, use of trained technicians, use of bar code-scanning software, and collaboration between registered dietitians and registered nurses on feeding safety in the NICU. METHODS/SEARCH STRATEGY: A systematic review of the literature was completed, and 12 articles were selected as relevant to search criteria. Study quality was evaluated using the Downs and Black scoring tool. FINDINGS/RESULTS: An evaluation of human studies indicated that the use of centralized milk preparation, trained technicians, bar code-scanning software, and possible registered dietitian involvement decreased feeding-associated error in the NICU. IMPLICATIONS FOR PRACTICE: A state-of-the-art NICU includes a centralized milk preparation area staffed by trained technicians, care supported by bar code-scanning software, and utilization of a registered dietitian to improve patient safety. These resources will provide nurses more time to focus on nursing-specific neonatal care. IMPLICATIONS FOR RESEARCH: Further research is needed to evaluate the impact of factors related to feeding safety in the NICU as well as potential financial benefits of these quality improvement opportunities.

Bone metabolism in very preterm infants receiving total parenteral nutrition: do intravenous fat emulsions have an impact?

Very preterm infants (<32 weeks' gestation) are at high risk for impaired skeletal development because of factors that limit the provision of extrauterine nutrients. Cumulative net deficiencies of calcium, phosphorus, docosahexaenoic acid (DHA), and arachidonic acid (ARA) are evident in these infants after prolonged administration of total parenteral nutrition (TPN). This is significant because minerals as well as metabolites of DHA and ARA are important modulators of bone cell differentiation, lengthening of bone, and bone matrix deposition. Furthermore, diets containing only precursors of DHA and ARA result in suboptimal skeletal growth. With the emergence of new intravenous lipid emulsions, it is important to understand the impact of fatty acids on bone metabolism in the third trimester in order to optimize the provision of TPN in very preterm infants. The purpose of this review is to evaluate current evidence regarding intravenous lipid emulsions and bone metabolism in very preterm infants receiving prolonged TPN and to identify areas of research needed.

Determination of digestibility, tissue deposition, and metabolism of the omega-3 fatty acid content of krill protein concentrate in growing rats.

Krill protein concentrate (KPC) consists of high-quality protein (77.7% dry basis) and lipids (8.1% dry basis) that are rich (27% of total fatty acids) in omega-3 polyunsaturated fatty acids (omega-3 PUFAs). The objective of the study was to determine digestibility, tissue deposition, metabolism, and tissue oxidative stability of the omega-3 PUFAs provided by KPC. Young female Sprague-Dawley rats (n = 10/group) were fed ad libitum isocaloric diets for 4 weeks with either 10% freeze-dried KPC or 10% casein. The casein diet contained 5.3% added corn oil (CO), whereas the KPC contained 5.3% total lipids from 0.9% krill oil (KO) provided by KPC and 4.4% added corn oil (KO + CO). Fatty acid compositions of various tissues were analyzed by gas chromatography. Lipid peroxidation was determined by thiobarbituric acid reactive substances (TBARS). Total antioxidant capacity and urinary eicosanoid metabolites were determined by enzyme immunoassay. The omega-3 PUFAs provided in KO from KPC increased (P = 0.003) docosahexaenoic acid (DHA) concentration in the brain. DHA and eicosapentaenoic acid (EPA) content in fat pads and liver were increased (P < 0.01), whereas the omega-6 PUFA, arachidonic acid (AA), was decreased (P < 0.01) in rats fed the KPC diet containing the KO + CO mixture compared to rats fed the casein diet containing pure CO. Feeding the KPC diet decreased pro-inflammatory 2-series prostaglandin and thromboxane metabolites. There was no significant difference in TBARS or total antioxidant capacity in the tissues of rats fed the different diets. On the basis of the study results, the low amount of omega-3 PUFAs provided by the KO content of KPC provides beneficial effects of increasing tissue EPA and DHA deposition and reduced AA-derived 2-series eicosanoid metabolites without increasing lipid peroxidation. Therefore, consumption of KPC has the potential to provide a healthy and sustainable source of omega-3 PUFAs.