TO STUDY THE EFFECT OF POOLED PASTEURIZED DONOR HUMAN MILK VERSUS UNPOOLED PASTEURIZED PRETERM DONOR HUMAN MILK ON THE SHORT TERM GROWTH PARAMETERS OF PRETERM INFANTS - A ONE YEAR RANDOMIZED CONTROLLED TRIAL AT KLE, DR.PRABHAKAR KORE HOSPITAL AND MRC, BELAGAVI.

Abstract

Background and objectives Adequate nutrition is of outmost importance for ensuring the optimal growth and development especially in preterm infants. Breast milk with it’s ideal nutrient composition is known to achieve the optimal growth and development. Feeding difficulties and inadequate milk production are the major challenges in providing optimal nutrition for the preterm infants since most of the mothers of preterm infants experience delayed lactogenesis II and are unable to provide adequate milk to their infants during the initial days. Under these circumstances when mothers milk is not available, WHO and UNICEF recommends using Pasteurized Donor Human Milk (PDHM) as the next best infant feeding option. Pasteurized donor human milk (PDHM) is the pooled donor mothers milk which is distributed through human milk bank. Human milk bank systematically collects, pasteurizes, stores and distribute the donor human milk. PDHM in known to confer several advantages in preterm infants including feeding tolerance, reducing risk of Late Onset Sepsis (LOS), Necrotizing Enterocolitis (NEC), Bronchopulmonary Dysplasia (BPD) and Retinopathy of Prematurity (ROP). However, effect of PDHM in improving the growth parameters in preterm infants is controversial. Several studies have reported that babies fed with PDHM have no significant difference in gain in weight, length and head circumference at discharge when compared to preterm formula fed infants.The human milk composition of mothers who have given birth to preterm infants is different from that of mothers delivering term infants with protein content as high as 4.1 ± 2.1 g/100 ml in early preterm milk . Also the processes like freezing, thawing and pasteurization are known to modify the macronutrient content of donor human milk . PDHM xi dispensed in human milk banks is a combination of pooled milk from both preterm and term donor mothers of different gestational age postpartum, which may affect the donor human milk composition and in turn may affect the growth outcomes of infants. This variability in human milk composition along with effect of pasteurization and routine practice of pooling both term and preterm milk together may be attributed to the effects on growth of preterm infants fed with PDHM .There is a lack of evidence to show the effect of pooled pasteurized preterm milk on the growth outcomes of infants. Therefore we conducted a RCT to study the effect of pooled pasteurized donor human milk versus unpooled pasteurized (pooling of only preterm donor milk) preterm donor human milk on the short term growth parameters ( weight, length , head-circumference and mis- upper arm circumference) of preterm infants.