387 Enteral Nutrition and Use of Human Milk Fortifiers in Preterm Infants; An International Survey

Abstract

Background and aims: Optimal enteral nutrition is of critical importance to preterm infants, but there is limited evidence on benefits and safety of different feeding regimens including use of human milk fortifiers (HMF). We sought to determine feeding practice and use of HMF in neonatal units from different countries and continents.

Methods: An internet-based questionnaire was sent by email to a single neonatologist in 120 tertiary units in Australasia, Canada, Scandinavia and UK.

Results: 111 units (92%) responded. Fifty-four units (49 %) had either a breast milk bank or access to donor milk (Australasia 2/24, Canada 6/25, Scandinavia 20/20 and UK 26/42). Enteral feeding was initiated in the first 24 hours of life in 42 units (38 %) if GA < 25 weeks, in 50 units (45 %) if GA 25- 27 weeks and in 81 units (73%) if GA 28-31 weeks. For infants with GA < 25 weeks 55 units (50 %) used 4-5 days minimal enteral feeding before grading up feeding volume. Target feeding volume was 160- 180 ml/kg/d in 62 units (56 %). Ninety units (81 %) routinely used a multi-component HMF. Most (85 %) used birth weight as criteria for which infants to be given HMF. Twenty-nine units added HMF when infants tolerated a feeding volume of 80-120 ml/kg/ day and 43 units waited until infants tolerated “full feeds” (≥150 ml/kg/day).

Conclusions: This study examines key areas of uncertainty and shows that feeding practices demonstrate enormous variability. It provides data that will be useful in planning collaborative feeding trials.

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