Human milk fortification with differing amounts of fortifier and its association with growth and metabolic responses in preterm infants

J Hum Lact. 2013 Aug;29(3):400-5. doi: 10.1177/0890334412459903. Epub 2012 Nov 29.


Background: Fortification of human milk (HM) is a common clinical practice to adapt breast milk to the nutritional needs of very low birth weight (VLBW) infants. The optimal method for HM fortification remains to be determined, and a variety of protocols are currently used in neonatal intensive care units.

Objective: It is believed that standard fortification is insufficient to meet the needs of VLBW infants. Therefore, we designed a randomized prospective study that investigated the effects of varying levels of blind fortification on short-term growth and metabolic responses of preterm infants.

Methods: Eligible infants were randomized into 3 groups: standard fortification (SF), moderate fortification (MF), and aggressive fortification (AF). Short-term growth, feeding intolerance, and urea, calcium, phosphorus, and alkaline phosphatase levels were assessed.

Results: There were 26, 29, and 29 infants in the SF, MF, and AF groups, respectively. The baseline characteristics of the groups were similar. Daily weight gain and length at discharge did not differ among the groups; however, head circumference was significantly higher in the MF and AF groups compared with the SF group. Urea, calcium, phosphorus, and alkaline phosphatase levels were similar between the groups.

Conclusion: We demonstrated that blind fortification of HM, even with higher amounts than recommended by manufacturers, did not cause any measured adverse effects on the metabolic response of preterm infants. Anthropometric measurements (except head circumference) were not different between the different dosages of fortification.

Keywords: breastfeeding; fortification; growth; human milk; metabolic response; prematurity.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Biomarkers / blood
  • Body Height
  • Double-Blind Method
  • Enteral Nutrition / methods*
  • Female
  • Food, Fortified*
  • Head / growth & development
  • Humans
  • Infant Care / methods*
  • Infant, Newborn
  • Infant, Premature / blood
  • Infant, Premature / growth & development*
  • Infant, Very Low Birth Weight / blood
  • Infant, Very Low Birth Weight / growth & development*
  • Male
  • Milk, Human*
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Weight Gain


  • Biomarkers