Am J Perinatol
DOI: 10.1055/a-2164-7957
Original Article

Transient Hypoglycemia and Biochemical Differences in Infants Less Than 1,250 G at Birth Fed Human Milk with Human Milk–Derived Fortifier versus Cow Milk–Derived Fortifier

Millie R. Chang
1   Division of Neonatology, CHOC Pediatric Subspecialty Faculty Inc., Orange, California
Manas Tetarbe
2   Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
Lorayne Barton
2   Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
2   Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
Rowena Cayabyab
2   Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
› Author Affiliations
Funding None


Objective Fortification of human milk (HM) with either human milk-derived fortifier (HMDF) or cow milk-derived fortifier (CMDF) is important in preterm infants. The objective is to compare the incidence of hypoglycemia, and biochemical values in infants less than 1,250 g at birth fed HMDF versus CMDF.

Study Design It is a retrospective cohort study on infants less than 1,250 g at birth who were fed with HMDF or CMDF. Hypoglycemia was defined as blood glucose (BG) level equal to or less than 60 mg/dL within 72 hours of full enteral feeds when off total parenteral nutrition and intravenous fluids.

Results Ninety infants were enrolled (HMDF = 61, CMDF = 29). HMDF group had a higher rate of hypoglycemia (46 vs. 24%; p = 0.048) after achievement of full enteral feeding. The median minimum BG was lower (61 vs. 71; p ≤ 0.01), while blood urea nitrogen (12 vs. 6; p ≤ 0.01) and albumin (3.1 vs. 2.7; p ≤ 0.01) were higher in HMDF group compared with CMDF.

Conclusion At full enteral feedings in infants less than 1,250 g at birth, an HMDF diet may predispose to hypoglycemia needing intervention. Close monitoring of BG levels once off parenteral nutrition is recommended.

Key Points

  • Exclusive human milk (EHM) feeding results in better nutritional indices.

  • EHM feeding at higher calorie/ounce improves growth.

  • Blood glucose needs to be monitored when off TPN during EHM feeding.

Author's Contributions

M.R.C. was responsible for creating the database, data collection and analysis, results interpretation, and writing the manuscript. M.T. contributed to database creation, data analysis, results interpretation, and writing the manuscript. L.B. contributed to gathering the demographic data from the database and writing the manuscript. R.R. contributed to study design, results interpretation, and revising the manuscript. R.C. contributed to study design, data analysis, results interpretation, and writing the manuscript.

Publication History

Received: 12 April 2023

Accepted: 30 August 2023

Accepted Manuscript online:
01 September 2023

Article published online:
25 September 2023

© 2023. Thieme. All rights reserved.

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