Table 4.
Data Summary of Trials Comparing Growth in Infants Fed Unsupplemented HM With Those Fed Protein-Supplemented HM.
| Study | Study Description |
Outcomes and Results |
Quality | |||
|---|---|---|---|---|---|---|
| Participants | Intervention | Intakes | Growth | |||
| Kashyap et al29 (1990), United States | EN n = 66 | BW: 900-1750 g | Group 1 (n = 14): | Study period, mean (SD) | Study period, mean (SD) | Neutral |
| DO n = 24 | GA: N/D | Mothers HM | Energy, kcal/kg/d; Group 1: 129 (11), Group 2: 131 (12), P N/D | Δ Weight, g/kg/d; Group 1: 17 (2), Group 2: 21 (2), P < .01 | ||
| CP n = 27 | SGA and AGA infants included | Group 2 (n = 13): | Protein, g/kg/d; Group 1: 2.5 (0.5), Group 2: 3.2 (0.4), P N/D | Δ Length, cm/wk; Group 1: 0.9 (0.2), Group 2: 1.3 (0.5), P NS | ||
| SS: enteral feedings 180 mL/kg/d | Healthy infants | Mothers HM + protein (1.1 g/kg/d), Ca (3.7 mmol/kg/d), P (2.1 mmol/kg/d), Na (1.1 mmol/kg/d) | Δ HC, cm/wk; Group 1: 1.0 (0.2), Group 2: 1.2 (0.2), P NS | |||
| SE: infant weight 2200 g | Reports groups 1 and 2 isocaloric due to variation in composition of HM | |||||
| Group 3 excluded | ||||||
| Not isocaloric | ||||||
| Target volume: 180 mL/kg/d | ||||||
| HM composition: daily samples pooled for weekly analysis | ||||||
| Polberger et al30 (1989), Sweden | EN n = 34 | BW: <1500 g | HM excluded | Study period, mean (SD) | Study period, mean (SD) | Neutral |
| DO n = 6 | GA: N/D | Not isocaloric | Energy, kcal/kg/d; HMF: 121 (10) | Δ Weight, g/kg/d; HMF: 16 (2), HMP: 20 (1), P N/D | ||
| CP n= 5 (mothers milk), n = 10 (little mothers milk) | AGA | HM + HMF (n = 8): | HMP: 117 (9), P N/D | Δ Length, cm/wk; HMF: 0.9 (0.2), HMP: 1.3 (0.1), P N/D | ||
| SS: stable on 170 mL/kg/d | Tolerance of complete enteral feeding | HM with human milk fat (1 g/100 mL) | Protein, g/kg/d; HMF: 2.1 (0.3) | Δ HC, cm/wk; HMF: 1.1 (0.2), HMP: 1.2 (0.1), P N/D | ||
| SE: 2200 g or breastfeeding initiated | Healthy infants | HM + HMP (n = 9): | HMP: 3.6 (0.2), P N/D | |||
| HM with human milk protein (1 g/100 mL) | ||||||
| HM + HMPF excluded | ||||||
| Not isocaloric | ||||||
| Groups HM + HMP and HM + HMF isocaloric due to addition of fat | ||||||
| Target volume: 170 mL/kg/d | ||||||
| HM composition: daily aliquot of milk pooled for weekly analysis | ||||||
| Greer and McCormick31 (1988), United States | EN n = 38 | BW: <1600 g | HM (n = 10): Mothers HM | First 6 weeks enteral feeds, mean (SD) | First 6 weeks enteral feeds, mean (SD) | Neutral |
| DO n = N/D | GA: <32 weeks | FHM (n = 10): | Energy, kcal/kg/d; HM: 112 (10), FHM: 105 (15), P NS | Δ Weight, g/kg/d; HM: 13 (1), FHM: 17 (2), P < .01 | ||
| CP n= N/D | Healthy infants | Mothers HM + protein (0.9 g/100 mL), Ca (90 mg/100 mL), P (45 mg/100 mL) | Protein, g/kg/d; HM: 3.3 (0.6), FHM: 4.2 (0.5), P < .01 | Δ Length, cm/wk; HM: 0.8 (0.2), FHM: 1.1 (0.2), P < .01 | ||
| SS: full oral feedings achieved (120 kcal/kg/d) | AGA | HM groups similar energy intake due to higher volume feeds in HM group | Δ HC, cm/wk; HM: 0.8 (0.2), FHM: 1.1 (0.2), P < .02 | |||
| SE: 6 weeks from study start | Formula groups excluded | |||||
| Not isocaloric | ||||||
| Target volume: 120-200 mL/kg/d | ||||||
| HM composition: 5% daily aliquots of feeds pooled for weekly analysis | ||||||
| Putet et al32 (1987) | EN n = 16 | BW: <1500 g | HM (n = 8): Pooled HM | Study period (3 days), mean (SD) | 7 days overlapping balance study, mean (SD) | Neutral |
| DO n = 0 | GA: N/D | HM-Pr (n = 8): | Energy, kcal/kg/d; HM: 107 (7), HM-Pr: 106 (14), P > .05 | Δ Weight, g/kg/d; HM: 15 (3), HM-Pr: 17 (2), P > .05 | ||
| CP n = 16 | Gender: male | Pooled HM + 1 g sup/100 mL, providing (/100 g powder): | Protein*, g/kg/d; HM: 2.5 (0.4), HM-Pr: 3.8 (0.5), P < .01 | Δ Length, cm/wk; HM: 1.1 (0.3), HM-Pr: 1.2 (0.3), P > .05 | ||
| SS: N/D | Healthy infants | Nitrogen: 13.2 g, lipid: 1.4 g, Ca: 2.5 g, P: 1.1 g, Na: 8.0 mg | *Calculated as total Nitrogen × 6.25 | Δ HC, cm/wk; HM: 1.0 (0.1), HM-Pr: 1.2 (0.2), P > .05 | ||
| SE: 7 days after study start | Isocaloric due to higher volume feeds of HM group | |||||
| Target volume: N/D | ||||||
| HM composition: one aliquot taken from entire pool of milk for study | ||||||
| Ronnholm et al33 (1986) | EN n = 54 | BW: <1500 g | HM (n = 23): | 2 weeks of age, mean (SEM) | Weeks 1-6, mean (SEM) | Neutral |
| DO n = 10 | GA: ≤36 wk | Unsupplemented HM | Energy, kcal/kg/d; HM: 111 (3), HM-Pr: 110 (4), P N/D | Δ Weight, g/kg/d; HM: 10 (1), HM-Pr: 13 (1), P < .01 | ||
| CP n = 44 | SGA and AGA | HM-Pr (n = 21): | Protein, g/kg/d; HM: 1.8 (0.1), HM-Pr: 3.2 (0.2), P N/D | Δ Length, cm/wk; HM: 0.8 (0.1), HM-Pr: 1.0 (0.1), P = .04 | ||
| SS: N/D | Healthy infants | HM + HM protein (0.9 g/100 mL of milk) | 6 weeks of age, mean (SEM) | Δ HC, cm/wk; HM: 0.6 (0.0), HM-Pr: 0.7 (0.0), P = .13 | ||
| SE: N/D | All infants fed either pooled banked mature HM or mothers HM | Energy, kcal/kg/d; HM: 130 (3), HM-Pr: 133 (2), P N/D | ||||
| Reason for similarity of energy intake between groups N/D | Protein, g/kg/d; HM: 1.9 (0.0), HM-Pr: 3.7 (0.1), P N/D | |||||
| Target volume: 200 mL/kg/d | ||||||
| HM composition: 5 mL samples taken at beginning and end of each milking | ||||||
Abbreviations: AGA, appropriate for gestational age; BW, birth weight; Ca; calcium; CP, completed study protocol; DO, dropouts, that is, not included in growth outcomes; EN, enrolled; GA, gestational age; HC, head circumference; HM, human milk; LBW, low birth weight; Na, sodium; NS, nonsignificant; N/D, not described; OFC, occipito-frontal circumference; P, phosphorous; SGA, small for gestational age; SD, standard deviation; SEM, standard error of the mean; SE, study end; SS, study start; VLBW, very low birth weight.