Project 451690

There has been a dramatic shift in how very low birth weight (born <1500 g, VLBW) infants are fed in Canadian neonatal intensive care units in the last 10 years, moving from predominantly formula to human milk feeding. This change has occurred as the result of strong evidence that use of human milk can reduce the risk of serious morbidities such as sepsis and necrotizing enterocolitis (NEC) and thus could be life-saving. Unlike preterm formula where the energy and nutrient content is constant, human milk composition varies widely from mother-to-mother, over time of day, days postpartum, and how it is collected and stored. This presents a challenge when feeding VLBW infants who require nutrient fortification of their feeds to meet their very elevated nutritional requirements to support growth and normal neurodevelopment but who also have immature excretory mechanisms for eliminating nutrients and breakdown products not required by the body. Human milk-fed infants, particularly those with comorbidities and fed predominantly pasteurized donor human milk, frequently have suboptimal growth including head growth; the latter prognostic of later neuroimpairment. Individualized fortification may be a reasonable approach to address suboptimal energy and nutrient intake and growth by accounting for variability in human milk composition and/or and an infant's metabolic response to enteral nutrition provided. To assess this, health care professionals and families from a large consortium of neonatal units that have worked successfully in the past on other early feeding issues of VLBW infants have assembled to evaluate the benefits, risks and costs of individualized fortification. While the feeding intervention will occur in hospital, infants will be followed for approximately two years to assess their growth, body composition, frequency of morbidity and neurodevelopment. This study will be pivotal in setting feeding guidelines for VLBW infants in Canada and globally.