Comparative characterization the fortification of different types of nutrition for preterm and sick infants. What's the best? (Systematic review)

Abstract

Human milk is the preferred feeding for all infants, including those of very low birth weight and vulnerable groups. However, mother’s milk is generally likely has insufficient protein to promote appropriate growth. That's why fortification of human milk is required to meet nutrient requirements for growth and development for these preterm infants who are at high risk for growth faltering during the hospital stay. There are multiple strategies and products that may be employed to support desired growth rates. Purpose - Conduct comparative analysis the current literature on the fortification own mothers’ milk and influence of this fortification on the outcomes for preterm and sick infant’s health. Materials and methods. Search Strategy: A systematic search of the literature was conducted using search strategy was based on MeSH terms/subject headings and separate keywords. The study designs included were randomized or quasi-randomized controlled trials in the English, Ukrainian and Russian languages. Study Selection: Published literature was searched from January 2010 up to July, 1, 2022 using five databases (PubMed, Ovid Medline, Web of Science, Ovid Embase, and the Cochrane Library). The search resulted in 75 articles, and an additional article was identified by an expert in the field; 20 were used for review. Data Extraction: Data from the full-text articles was extracted into a Table. The manuscripts were organised in the table as follows: first Cochrane reviews and systematic reviews, followed by individual research studies that were not cited in any of the systematic reviews. Results and conclusions. The primary outcomes of this review were influence of different types fortification of mother's milk and time of starting fortification in short term growth parameters (length, head growth, and weight gain), feeding intolerance (defined as clinical signs only and/or cessation of feeding), length of hospital stay (number of days that the baby remained in the neonatal unit), and post menstrual age (i.e., gestational age plus chronological age) at discharge. Secondary outcomes were narcotising enterocolitis and sepsis. The study results suggested that early human milk fortification appears to positively affect growth for infants whose human milk feedings are fortified with a fortifier without adverse effects. Implications for Practice: Adequate nutrition in the early weeks of life is rarely achieved in premature infants, resulting in extrauterine growth restriction. The use of fortified human milk produces adequate growth in premature infants and satisfies the specific nutritional requirements of these infants. The use of individualised fortification is recommended but with proper protocols. No conflict of interests was declared by the authors.