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Comment & Response
November 2016

Supplemental Feedings for the High-Risk Preterm Infants—Reply

Author Affiliations
  • 1Department of Pediatrics, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
  • 2Department of Pediatrics, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
JAMA Pediatr. 2016;170(11):1114-1115. doi:10.1001/jamapediatrics.2016.2358

In Reply We would like to thank Eidelman, Lima et al, Perrin and Sisk, and Verd for their interest in our recently published article1 and their responding letters to the editor. They discuss important considerations when interpreting our results. As discussed in our article, we acknowledge that the intervention period of our trial was short. We explicitly decided on the 10-day period because a specific goal was to test the hypothesis that the protective effect of human milk against sepsis and necrotizing enterocolitis (NEC) could arise from avoiding immunogenic cow’s milk proteins.2 Therefore, we aimed to compare a completely human milk–based diet with a diet that also contained cows’ milk protein. In the Netherlands, we do not have access to a human milk–based fortifier, and we deemed it unacceptable to postpone the introduction of cow’s milk–based fortifier for longer than 10 days following birth. Furthermore, our retrospective study showed that intake during the first 10 days after birth was associated with morbidity and mortality during the first 60 days.3 Finally, these first postnatal days were suggested to be important for intestinal maturation, with a delay seen in formula-fed infants resulting in a longer period with intestinal permeability in these infants.4 Our results showed no detrimental effect of cow’s milk protein exposition (formula) in the first 10 days after birth.1 This finding justifies further randomized trials with donor milk, supplemented with cow’s milk–based fortifier when needed, conducted through longer periods. We agree that those trials are warranted, considering the costs of running a human milk bank.

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