A Cochrane review included 2 studies with a total of 246 preterm infants. Supplementation of human breast milk following hospital discharge with more than one nutrient (protein, fat, carbohydrate, or minerals [calcium and/or phosphate]) was compared to feeding with unsupplemented human milk. Supplementation with electrolytes, vitamins, or trace minerals in addition to only one of the above nutrients was not classified as multinutrient fortification.
Multinutrient fortification of breast milk for 3 to 4 months after hospital discharge did not affect rates of growth at 3 to 4 months corrected age or weight or head circumference at 12 months corrected age, but infants in the intervention group were borderline statistically significantly longer than control infants at 12 months corrected age (table ). There was statistically significant heterogeneity, in each case one study found a larger (and statistically significant) mean difference than the other study. One study assessed infants at 18 months corrected age and did not find any statistically significant effects on neurodevelopmental outcomes. The identified studies reported very limited data on developmental outcomes and have not yet assessed any longer-term growth or health outcomes.
| Outcome | Effect size (95% CI) | Participants (studies) |
|---|---|---|
| Weight (g) 3-4 months corrected age | MD 138.26 g (-89.87 to 366.40) | 236 (2) |
| Weight (g) 12 months corrected age | MD 255.25 g (-93.40 to 603.90) | 211 (2) |
| Head circumference (cm) 3-4 months corrected age | MD 0.22 cm (-0.15 to 0.58) | 235 (2) |
| Head circumference (cm) 12 months corrected age | MD 0.16 cm (-0.27 to 0.60) | 197 (2) |
| Length (cm) 3-4 months corrected age | MD 0.60 cm (-0.14 to 1.33) | 236 (2) |
| Length (cm) 12 months corrected age | MD 0.88 cm (0.01 to 1.74) | 211 (2) |
Comment: The quality of evidence is downgraded by inconsistency (unexplained variability in results), and by imprecise results (few patients).