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It has been observed that target fortification on different schedules leads to meal to meal variation. It changes the ratio of protein to energy and the percentage of carbohydrate to non-protein energy which may, affect growth. In the past, the investigators have analyzed the outcomes of breast milk composition when target fortification is done with different analysis schedules. The investigators were able to measure the macronutrient intake for different milk analysis schedules via a theoretical model and show that the more frequent schedules reduce the variation of fortified-breast milk, whereas a reduced schedule leads to a high variation of macronutrients. It was observed that, in all the breast milk samples measured twice per week, infants achieved on average the recommended macronutrients in line with current recommendations. Nonetheless, the model only looks at the macronutrient intake and does not investigates the relationship between macronutrient variation and its effect on growth.
The aim of the current study is to compare a frequent schedule of measurement of macronutrient analysis with a reduced schedule of measurement and to study its affect on growth, protein accretion and metabolic parameter.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 5 milk analysis | Experimental |
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| 1 milk analysis | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fortification with modular protein | Dietary Supplement | Modular product supplementation is based on most recent breast analysis done for the participant. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Growth during first three weeks of intervention | first three weeks during intervention before 36 weeks of gestation |
| Measure | Description | Time Frame |
|---|---|---|
| Daily Nutrient intake (kcal, lactose, protein, fat) measured with conventional milk analysis | from inclusion at postmenstrual age <30 weeks until 36 weeks of gestation | |
| Weight Gain | from inclusion at postmenstrual age <30 weeks until 36 weeks of gestation or discharge |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Christoph Fusch, MD, PhD | Contact | +1 521 2100 | 75721 | fusch@mcmaster.ca |
| Niels Rochow, MD | Contact | +1 521 2100 | 23106 | rochow@mcmaster.ca |
| Name | Affiliation | Role |
|---|---|---|
| Christoph Fusch, MD, PhD | McMaster Children's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Health Science, McMaster Children's Hospital | Hamilton | Ontario | L8S 4K1 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23769498 | Background | Rochow N, Fusch G, Choi A, Chessell L, Elliott L, McDonald K, Kuiper E, Purcha M, Turner S, Chan E, Xia MY, Fusch C. Target fortification of breast milk with fat, protein, and carbohydrates for preterm infants. J Pediatr. 2013 Oct;163(4):1001-7. doi: 10.1016/j.jpeds.2013.04.052. Epub 2013 Jun 12. | |
| 23782538 | Background |
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| Fortification with modular carbohydrate | Dietary Supplement | Modular product supplementation is based on most recent breast analysis done for the participant. |
|
| Fortification with modular fat | Dietary Supplement | Modular product supplementation is based on most recent breast analysis done for the participant. |
|
| Oxidative stress by 8-Oxo-2'-deoxyguanosine metabolites in urine | Measured by mass spectroscopy | from inclusion at postmenstrual age <30 weeks until discharge |
| Protein synthesis analyzed by nitrogen excretion in urine [µmol/mL] | first three weeks during intervention before 36 weeks of gestation |
| Feeding intolerance questionaire | volume of gastric residuals, color of gastric residuals, vomiting, abdominal girth, abdominal distention | from inclusion at postmenstrual age <30 weeks until discharge |
| Fat mass [g] | Measured with bioelectrical impedance analysis | from inclusion at postmenstrual age <30 weeks until discharge |
| Lean mass [g] | Measured with bioelectrical impedance analysis | from inclusion at postmenstrual age <30 weeks until discharge |
| Head circumference [cm] | Measured by tape | from inclusion at postmenstrual age <30 weeks until discharge |
| Body length [cm] | Measured by length board | from inclusion at postmenstrual age <30 weeks until discharge |
| Choi A, Fusch G, Rochow N, Sheikh N, Fusch C. Establishment of micromethods for macronutrient contents analysis in breast milk. Matern Child Nutr. 2015 Oct;11(4):761-72. doi: 10.1111/mcn.12053. Epub 2013 Jun 18. |
| 22041090 | Background | Fusch G, Choi A, Rochow N, Fusch C. Quantification of lactose content in human and cow's milk using UPLC-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2011 Dec 1;879(31):3759-62. doi: 10.1016/j.jchromb.2011.09.053. Epub 2011 Oct 6. |
| 24912866 | Background | Fusch G, Rochow N, Choi A, Fusch S, Poeschl S, Ubah AO, Lee SY, Raja P, Fusch C. Rapid measurement of macronutrients in breast milk: How reliable are infrared milk analyzers? Clin Nutr. 2015 Jun;34(3):465-76. doi: 10.1016/j.clnu.2014.05.005. Epub 2014 May 17. |
| 25213193 | Background | Fusch G, Mitra S, Rochow N, Fusch C. Target fortification of breast milk: levels of fat, protein or lactose are not related. Acta Paediatr. 2015 Jan;104(1):38-42. doi: 10.1111/apa.12804. Epub 2014 Oct 2. |
| 25807355 | Background | Rochow N, Landau-Crangle E, Fusch C. Challenges in breast milk fortification for preterm infants. Curr Opin Clin Nutr Metab Care. 2015 May;18(3):276-84. doi: 10.1097/MCO.0000000000000167. |
| 25835073 | Background | Rochow N, Fusch G, Zapanta B, Ali A, Barui S, Fusch C. Target fortification of breast milk: how often should milk analysis be done? Nutrients. 2015 Apr 1;7(4):2297-310. doi: 10.3390/nu7042297. |
| 26663457 | Background | Fusch G, Kwan C, Huang RC, Rochow N, Fusch C. Need of quality control programme when using near-infrared human milk analyzers. Acta Paediatr. 2016 Mar;105(3):324-5. doi: 10.1111/apa.13305. Epub 2016 Jan 19. No abstract available. |
| 26863130 | Background | Choi A, Fusch G, Rochow N, Fusch C. Target Fortification of Breast Milk: Predicting the Final Osmolality of the Feeds. PLoS One. 2016 Feb 10;11(2):e0148941. doi: 10.1371/journal.pone.0148941. eCollection 2016. |
| 26927169 | Background | Kotrri G, Fusch G, Kwan C, Choi D, Choi A, Al Kafi N, Rochow N, Fusch C. Validation of Correction Algorithms for Near-IR Analysis of Human Milk in an Independent Sample Set-Effect of Pasteurization. Nutrients. 2016 Feb 26;8(3):119. doi: 10.3390/nu8030119. |