Open Access Highly Accessed Research article

Early feeding of fortified breast milk and in-hospital-growth in very premature infants: a retrospective cohort analysis

Christoph Maas, Cornelia Wiechers, Wolfgang Bernhard, Christian F Poets and Axel R Franz*

Author Affiliations

Department of Neonatology, University Children’s Hospital Tübingen, Calwerstr. 7, Tuebingen 72076, Germany

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BMC Pediatrics 2013, 13:178  doi:10.1186/1471-2431-13-178

Published: 4 November 2013



Fortified human milk may not meet all nutritional needs of very preterm infants. Early transition from complementary parenteral nutrition to full enteral feeds might further impair in-hospital growth. We aimed to investigate the impact of the cumulative intake of fortified human milk on early postnatal growth in a cohort of very low birth weight infants after early transition to full enteral feeds.


Retrospective single-centre observational study. Data are presented as median (interquartile range).


N = 206 very preterm infants were analysed (gestational age at birth 27.6 (25.6-29.6) weeks, birth weight 915 (668-1170) g). Full enteral feeds were established at postnatal day 8 (6-10) and adequate postnatal growth was achieved (difference in standard deviation score for weight from birth to discharge -0.105(-0.603 - -0.323)). Standard deviation score for weight from birth to day 28 decreased more in infants with a cumulative human milk intake >75% of all enteral feeds (-0.64(-1.08 - -0.34)) compared to those with <25% human milk intake (-0.41(-0.7 - -0.17); p = 0.017). At discharge, a trend towards poorer weight gain with higher proportions of human milk intake persisted. In contrast, we observed no significant difference for head circumference growth.


Our current standardized fortification of human milk may not adequately support early postnatal growth.

Early neonatal growth; Enteral feeding; Infant premature; Human milk