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Comment & Response
November 2016

Supplemental Feedings for High-Risk Preterm Infants

Author Affiliations
  • 1University of North Carolina at Greensboro, Greensboro
  • 2Novant Health Forsyth Medical Center, Winston-Salem, North Carolina
JAMA Pediatr. 2016;170(11):1112-1113. doi:10.1001/jamapediatrics.2016.2355

To the Editor Understanding the effect of exposure to bovine-based formulas and fortifiers is an important area of research for optimizing outcomes and feeding protocols for very low-birth-weight infants. In their article studying the effect of supplementing with donor milk vs preterm formula in the first 10 days of life when mother’s own milk was insufficient, Corpeleijn et al1 concluded “supplemental feeding during the first 10 days of life yielded similar short-term outcomes.”1 This conclusion deserves the important qualification “when infants are receiving greater than 85% intake from mother’s own milk” to put this study in context with what is known in the literature. Sisk et al2 found that very low-birth-weight infants who received at least 50% human milk intake during the first 14 days of life had necrotizing enterocolitis rates of 3.2% compared with 10.9% in infants who received less than 50% human milk intake (P < .05).2 In a small randomized trial where infants received 100% fortified donor human milk or 100% preterm formula, Cristofalo et al3 reported necrotizing enterocolitis rates of 3% vs 21%, respectively (P = .08). A 2016 retrospective study by Colaizy et al4 concluded that infants receiving a 100% formula diet had an increased risk of necrotizing enterocolitis compared with infants receiving at least 98% fortified mother’s milk (adjusted odds ratio, 12.1; 95% CI, 1.5-94.1).4

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