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![Access through your institution Buy or subscribe Human milk alone has insufficient nutrients to meet preterm infant requirements and a multi-nutrient fortifier, bovine milk-based (BMBF) or human milk-based (HMBF), is recommended. As the nutrient composition of BMBF and HMBF differs [1, 2], the biochemical effects may also differ; these differences have not yet been reported. This secondary analysis of a randomized controlled trial comparing BMBF and HMBF examined the biochemical response to the different fortifiers in preterm infants which were hypothesized to differ given different intakes of protein and iron [3]. Infants born <1250 g who met eligibility criteria for the Optimizing Mothers’ Milk for Preterm Infants (OptiMoM) trial (NCT02137473) were studied [3]. Following informed consent, infants were provided mother’s milk first then pasteurized donor milk as required and had BMBF or HMBF added to human milk feeds in a blinded fashion depending on their randomization. The HMBF group received Prolact+4 and +6 (Prolacta Bioscience, City of Industry, USA) commencing at 100 mL/kg/day (81 kcal/dL, 2.2 g/dL protein, 0.1 mg/dL iron) and 140 mL/kg/day (88 kcal/dL, 2.7 g/dL protein, 0.2 mg/dL iron), respectively. In the BMBF group, 0.4 g/dL intact protein modular (Beneprotein, Nestle, Minneapolis, USA) was added to donor milk and Similac Human Milk Fortifier (Abbott Nutrition, Columbus, USA) 1:50 and 1:25 commenced at 100 mL/kg/day (72 kcal/dL, 1.7 g/dL protein, 0.2 mg/dL iron) and 140 mL/kg/day (78 kcal/dL, 2.2 g/dL protein, 0.4 mg/dL iron), respectively. Parenteral nutrition was discontinued at 120 mL/kg/day, enteral volumes increased 10-25 mL/kg/day, full feeds were considered 160 mL/kg/day, and energy increases were implemented if weight gain was <15 g/kg/day using Prolact+8 (95 kcal/dL) or Neosure (88 kcal/dL, Abbott Nutrition, Columbus, USA) in HMBF and BMBF groups, respectively. Both groups received multivitamin drops containing 375IU vitamin A, 200IU vitamin D and 17.5 mg vitamin C daily. Vitamin D 200IU was given daily until 2 kg. Each infant received 2-3 mg/kg/day elemental iron after full fortification. These doses were chosen bearing in mind the different micronutrient composition of the two diets while providing the same supplementation to both groups and thus maintaining blinding. The intervention lasted until 84 days of age, hospital discharge or establishment of oral feeds. The initial trial found no group differences in feeding tolerance or growth [3]. This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support REFERENCES * Prolact+ H2MF. 2022. Prolacta Bioscience. https://www.prolacta.com/en/products/preterm-nutrition-products/#fortifier * Similac Human Milk Fortifier Powder. 2023. Abbott. https://abbottnutrition.com/similac-human-milk-fortifier-powder * O’Connor DL, Kiss A, Tomlinson C, Bando N, Bayliss A, Campbell DM, et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am J Clin Nutr. 2018;108:108–16. Article PubMed Google Scholar * Thoene M, Hanson C, Lyden E, Dugick L, Ruybal L, Anderson-Berry A. Comparison of the effect of two human milk fortifiers on clinical outcomes in premature infants. Nutrients. 2014;6:261–75. Article CAS PubMed PubMed Central Google Scholar * Schanler RJ, Groh-Wargo SL, Barrett-Reis B, White RD, Ahmad KA, Oliver J, et al. Improved outcomes in preterm infants fed a nonacidified liquid human milk fortifier: a prospective randomized clinical trial. J Pediatr. 2018;202:31–7.e2. Article PubMed Google Scholar Download references FUNDING Canadian Institutes of Health Research FHG129919, FDN143233. AUTHOR INFORMATION Author notes * These authors contributed equally: Phoebe Kigozi, Nicole Bando. AUTHORS AND AFFILIATIONS * Paediatrics, Sinai Health, Toronto, ON, Canada Phoebe Kigozi, Nicole Bando, Roselina Mahlase, Kirsten Kotsopoulos, Deborah L. O’Connor & Sharon Unger * Paediatrics, Nottingham University Hospitals, Nottingham, UK Phoebe Kigozi * Paediatrics, University of the Witwatersrand, Johannesburg, South Africa Roselina Mahlase * Nutritional Sciences, University of Toronto, Toronto, ON, Canada Deborah L. O’Connor & Sharon Unger * Izaak Walton Killam Health Centre, Halifax, NS, Canada Sharon Unger Authors * Phoebe Kigozi View author publications You can also search for this author inPubMed Google Scholar * Nicole Bando View author publications You can also search for this author inPubMed Google Scholar * Roselina Mahlase View author publications You can also search for this author inPubMed Google Scholar * Kirsten Kotsopoulos View author publications You can also search for this author inPubMed Google Scholar * Deborah L. O’Connor View author publications You can also search for this author inPubMed Google Scholar * Sharon Unger View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS PK, DLO, SU contributed to the design of the research; PK, NB, RM, KK contributed to the acquisition, analysis, or interpretation of the data. All authors participated in drafting or reviewing the work critically for important intellectual content, approve the final version to be published, and agree to be accountable for all aspects of the work. CORRESPONDING AUTHOR Correspondence to Sharon Unger. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kigozi, P., Bando, N., Mahlase, R. _et al._ Biochemical response in preterm infants fed a human versus bovine milk-based fortifier. _J Perinatol_ 44, 1689–1691 (2024). https://doi.org/10.1038/s41372-024-02089-w Download citation * Received: 10 December 2023 * Revised: 15 July 2024 * Accepted: 30 July 2024 * Published: 16 August 2024 * Issue Date: November 2024 * DOI: https://doi.org/10.1038/s41372-024-02089-w SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. 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Access through your institution Buy or subscribe Human milk alone has insufficient nutrients to meet preterm infant requirements and a multi-nutrient fortifier, bovine milk-based (BMBF) or
human milk-based (HMBF), is recommended. As the nutrient composition of BMBF and HMBF differs [1, 2], the biochemical effects may also differ; these differences have not yet been reported.
This secondary analysis of a randomized controlled trial comparing BMBF and HMBF examined the biochemical response to the different fortifiers in preterm infants which were hypothesized to
differ given different intakes of protein and iron [3]. Infants born <1250 g who met eligibility criteria for the Optimizing Mothers’ Milk for Preterm Infants (OptiMoM) trial
(NCT02137473) were studied [3]. Following informed consent, infants were provided mother’s milk first then pasteurized donor milk as required and had BMBF or HMBF added to human milk feeds
in a blinded fashion depending on their randomization. The HMBF group received Prolact+4 and +6 (Prolacta Bioscience, City of Industry, USA) commencing at 100 mL/kg/day (81 kcal/dL, 2.2 g/dL
protein, 0.1 mg/dL iron) and 140 mL/kg/day (88 kcal/dL, 2.7 g/dL protein, 0.2 mg/dL iron), respectively. In the BMBF group, 0.4 g/dL intact protein modular (Beneprotein, Nestle,
Minneapolis, USA) was added to donor milk and Similac Human Milk Fortifier (Abbott Nutrition, Columbus, USA) 1:50 and 1:25 commenced at 100 mL/kg/day (72 kcal/dL, 1.7 g/dL protein, 0.2 mg/dL
iron) and 140 mL/kg/day (78 kcal/dL, 2.2 g/dL protein, 0.4 mg/dL iron), respectively. Parenteral nutrition was discontinued at 120 mL/kg/day, enteral volumes increased 10-25 mL/kg/day, full
feeds were considered 160 mL/kg/day, and energy increases were implemented if weight gain was <15 g/kg/day using Prolact+8 (95 kcal/dL) or Neosure (88 kcal/dL, Abbott Nutrition,
Columbus, USA) in HMBF and BMBF groups, respectively. Both groups received multivitamin drops containing 375IU vitamin A, 200IU vitamin D and 17.5 mg vitamin C daily. Vitamin D 200IU was
given daily until 2 kg. Each infant received 2-3 mg/kg/day elemental iron after full fortification. These doses were chosen bearing in mind the different micronutrient composition of the two
diets while providing the same supplementation to both groups and thus maintaining blinding. The intervention lasted until 84 days of age, hospital discharge or establishment of oral feeds.
The initial trial found no group differences in feeding tolerance or growth [3]. This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your
institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access
to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read
our FAQs * Contact customer support REFERENCES * Prolact+ H2MF. 2022. Prolacta Bioscience. https://www.prolacta.com/en/products/preterm-nutrition-products/#fortifier * Similac Human Milk
Fortifier Powder. 2023. Abbott. https://abbottnutrition.com/similac-human-milk-fortifier-powder * O’Connor DL, Kiss A, Tomlinson C, Bando N, Bayliss A, Campbell DM, et al. Nutrient
enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am J Clin Nutr. 2018;108:108–16. Article PubMed
Google Scholar * Thoene M, Hanson C, Lyden E, Dugick L, Ruybal L, Anderson-Berry A. Comparison of the effect of two human milk fortifiers on clinical outcomes in premature infants.
Nutrients. 2014;6:261–75. Article CAS PubMed PubMed Central Google Scholar * Schanler RJ, Groh-Wargo SL, Barrett-Reis B, White RD, Ahmad KA, Oliver J, et al. Improved outcomes in
preterm infants fed a nonacidified liquid human milk fortifier: a prospective randomized clinical trial. J Pediatr. 2018;202:31–7.e2. Article PubMed Google Scholar Download references
FUNDING Canadian Institutes of Health Research FHG129919, FDN143233. AUTHOR INFORMATION Author notes * These authors contributed equally: Phoebe Kigozi, Nicole Bando. AUTHORS AND
AFFILIATIONS * Paediatrics, Sinai Health, Toronto, ON, Canada Phoebe Kigozi, Nicole Bando, Roselina Mahlase, Kirsten Kotsopoulos, Deborah L. O’Connor & Sharon Unger * Paediatrics,
Nottingham University Hospitals, Nottingham, UK Phoebe Kigozi * Paediatrics, University of the Witwatersrand, Johannesburg, South Africa Roselina Mahlase * Nutritional Sciences, University
of Toronto, Toronto, ON, Canada Deborah L. O’Connor & Sharon Unger * Izaak Walton Killam Health Centre, Halifax, NS, Canada Sharon Unger Authors * Phoebe Kigozi View author publications
You can also search for this author inPubMed Google Scholar * Nicole Bando View author publications You can also search for this author inPubMed Google Scholar * Roselina Mahlase View author
publications You can also search for this author inPubMed Google Scholar * Kirsten Kotsopoulos View author publications You can also search for this author inPubMed Google Scholar * Deborah
L. O’Connor View author publications You can also search for this author inPubMed Google Scholar * Sharon Unger View author publications You can also search for this author inPubMed Google
Scholar CONTRIBUTIONS PK, DLO, SU contributed to the design of the research; PK, NB, RM, KK contributed to the acquisition, analysis, or interpretation of the data. All authors participated
in drafting or reviewing the work critically for important intellectual content, approve the final version to be published, and agree to be accountable for all aspects of the work.
CORRESPONDING AUTHOR Correspondence to Sharon Unger. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer
Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Springer Nature or its licensor (e.g. a society or other
partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this
article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kigozi, P., Bando, N., Mahlase, R. _et
al._ Biochemical response in preterm infants fed a human versus bovine milk-based fortifier. _J Perinatol_ 44, 1689–1691 (2024). https://doi.org/10.1038/s41372-024-02089-w Download citation
* Received: 10 December 2023 * Revised: 15 July 2024 * Accepted: 30 July 2024 * Published: 16 August 2024 * Issue Date: November 2024 * DOI: https://doi.org/10.1038/s41372-024-02089-w SHARE
THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to
clipboard Provided by the Springer Nature SharedIt content-sharing initiative