A study of safety and effectiveness of amino-acids based multi-nutrient fortifier in preterm infants

Background: Fortification plays a vital role in supporting the nutritional requirements in the premature infants. Currently in India, fortifiers are either whole protein based or whey protein which are bovine milk- based, which has been associated with increased risk of feed intolerance and necrotizing enterocolitis (NEC), to circumvent this, an amino-acids based fortifier has been made available which provides more proteins (0.35 g/1 g sachet) thereby meeting the nutritional requirements of preterm infants. Aim was to study effect (safety and efficacy) of fortification with the amino-acids based fortifier (HMF-ADVANCE, Analeptik Biologicals) in premature infants admitted in the neonatal intensive care unit (NICU).Methods: A single centre pilot study was conducted on preterm infants with <1800 g birth weight and/or <32 gestational age, amino-acids based fortifier (AABF) was used as the fortification option once the infants reached 100 ml/kg/day feed volume. 1 g of HMF-ADVANCE was mixed in 25 ml of mother抯 own milk (MOM) and the fortification was continued till discharge from NICU.Results: A total 100 preterm infants were included for the study, mean gestational age (GA) was 29.38�61 weeks, mean birth weight was 1159.90�1.9. Growth outcomes at the end of the study: mean weight gain was 23.73�62 g/day, mean head circumference gain was 1.02�41 cm/week, mean length gain was 1.01�15 cm/week and weight gain velocity were 17.13�38 g/kg/day. Blood urea nitrogen (BUN) showed an increasing trend from baseline (before starting fortification: 3.2 mg/dl), 1 week after fortification (6.3 mg/dl) and at the end of study (11.2 mg/dl). AABF was also used in three neonates post NEC. There were no episodes of feed intolerance or necrotising enterocolitis episodes and none of neonates discontinued fortification till discharge from NICU.Conclusions: AABF was well tolerated without any feed intolerance episodes and helped to achieve optimal growth. AABF can be the optimal choice of fortification in low-birth-weight neonates.