Evidence backs post discharge supplement in premature babies

Almost half of babies born prematurely – before 37 weeks – experience growth failure due to additional dietary requirements that cannot be met through breastfeeding alone, they noted.

“Breast milk alone doesn’t always meet their increased dietary requirements”

Luise Marino

Currently, it is standard practice across the UK to provide exclusively breastfed preterm babies with a protein and mineral-packed supplement – breast milk fortifier – while in neonatal units.

However, the researchers highlighted that this practice was usually stopped prior to discharge from hospital when babies transitioned to oral breast milk feeds.

From this point, because breast milk fortifier supplements were not prescribed by GPs, the additional nutrients needed were largely obtained from bottle-fed formula, said the study authors.

They warned that this approach could affect the confidence of mothers to breastfeed and result in them choosing not to continue.

Clinicians at University Hospital Southampton NHS Foundation Trust looked at the effects of supplying the supplement to 32 mothers upon discharge for use at home for eight weeks.

They recommended to the women that four sachets of milk fortifier be added to 40ml of expressed breast milk, with 5ml administered orally before each breastfeed or eight times per day.

This provided an additional 191 kcal, six grams protein, 111mg phosphorus and 192mg calcium per day.

The study, published in the journal Archives of Disease in Childhood, found use of the fortifier after leaving hospital prevented a dip in babies’ weight and resulted in better growth at eight weeks and then at a year.

Parents who took part in a questionnaire about the study were positive about the use of breast milk fortifier at home, finding it easy to do.

They also reported feeling less worried about the growth of their babies, with mothers saying it helped boost confidence in their ability to breastfeed.

Due to the success of the study at University Hospital Southampton NHS Foundation Trust, the researchers are now looking to run a larger scale study at sites across the UK.

“In this small group of infants, this method appeared to improve growth”

Luise Marino

Study author Dr Luise Marino, clinical academic paediatric dietitian at Southampton Children’s Hospital, said: “Preterm infants are so vulnerable and breastfeeding is encouraged to best support premature babies’ needs but breast milk alone doesn’t always meet their increased dietary requirements.

She said: “Breast milk fortifier contains extra protein and minerals, such as phosphorus and calcium to promote bone growth, but it is currently stopped before premature babies are discharged home.

“As it is not available from GPs, this can lead to a reduction in growth at a crucial time in their development,” she noted.

Dr Marino added: “In this small group of infants, this method appeared to improve growth while also supporting, promoting and protecting breastfeeding in this vulnerable population group.”