Tailored Human milk fortification procedure Tailored milk fortification will be done twice a day (8 am and 8 pm) for each following 12 hour nursing shift. Standard fortification will be added first. The remainder amount of protein, lipids and carbohydrates required to meet the recommended by ESPGHAN doses will be acheived by adding single ingrediant nutrients.

Standard fortification will be added according to the unit protocol.

BPD - Bronchopulmonary Dysplasia

NEC - Necrotizing Enterocolitis

Weight Gain

VLBW - Very Low Birth Weight Infant

ROP - Retinopathy of Prematurity

The mean of three measurements per batch (3 x 2-3ml) will be used to calculate the required amount of extra fat, protein, and carbohydrate for the following 3 days of fortification using a predefined Excel spread sheet (Microsoft Inc, Redmond, Washington).
The intervention will consist of adding fat, protein, and/or carbohydrate to achieve target levels of macronutrients.
The defined macronutrient concentration in breast milk is 4.4 g/100 mL of fat, 3 g/100 mL of protein, and 8.8 g/ 100 mL of carbohydrate to meet the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines (6.6 g/kg/d of fat, 4.5 g/kg/d of protein, and 13.2 g/kg/d of carbohydrate) assuming an intake of 150 mL/kg/d.

Tailored enteral nutrition

Department of Neonatology and Neonatal Intensive Care Warsaw Medical University

Division of Neonatology and Neonatal Intensive Care, 1st Department of Obstetrics and Gynaecology, The Medical University of Warsaw

Targeted vs Standard Fortification of Breast Milk

Effect of Targeted vs Standard Fortification of Breast Milk on Growth and Development of Preterm Infants (≤ 32 Weeks): a Randomised Controlled Trial

the number of infants with mental development index (MDI) Bayley Scale of Development III

The number of patients NEC >1 stage as defined by Bell's criteria

The number of patients with (BPD) defined as oxygen requirement of > 21% at 28 days of life

The number of patients with LOS defined as a positive blood culture or a positive cerebral spinal fluid culture

The number of patients with ROP > grade I as defined as the World Health Organisation criteria

Deidentified participation data will be available on request from the corresponding author. Data reuse will be permitted for meta-analysis.

Joanna Seliga-Siwecka

Principal Investigator

Princess Anna Mazowiecka Hospital, Warsaw, Poland

Medical University of Warsaw

Institute of Mother and Child

This is a multi-centre superiority randomised parallel group, 1:1 allocation study.
After reaching 80 ml/kg/day of enteral feeding, patients will be randomised to receive standard fortification-SF (Bebilon HMF, Nutricia) or targeted fortification -TF (proteins, lipids,carbohydrates). Allocation will be performed electronically.

The decision to start fortification will be made by the attending physician blinded to the intervention allocated. An employee outside the research team will feed data into the computer in separate datasheets so that the researchers can analyse data without having access to information about the allocation.

In the intervention group, mothers will be asked to provide at least 1 feed of fresh milk (i.e. within 4 hours of milk expression) per day.Other time, feed frozen milk.

Necrotizing Enterocolitis

Mothers will be asked to provide at least 1 feed of fresh milk (i.e. within 4 hours of milk expression) per day, other time, feed frozen milk

Fresh Milk

Zhengzhou Children's Hospital

Pilot Study of the Feasibility of Feeding Preterm Infants With Fresh Versus Frozen Mother's Own Breast Milk in the NICU

Feasibility as defined by the percentage of mothers who can provide at least 1 feed of fresh milk a day from study enrollment until the infants are 32 weeks CGA

retinopathy of prematurity/carbohydrate

Targeted vs Standard Fortification of Breast Milk

Pilot Study of the Feasibility of Feeding Preterm Infants With Fresh Versus Frozen Mother's Own Breast Milk in the NICU

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