Human Milk Fortification: A Practical Analysis of Current Evidence

Growth and Neurodevelopmental Outcomes of Preterm Infants Born < 26 Weeks Gestation before and after Implementation of a Nutrition-Care Bundle

BACKGROUND

This study aimed to assess the impact of a nutrition-care bundle on growth and neurodevelopmental outcomes of micro-preterm infants born in a level III neonatal intensive care unit (NICU) by two years corrected age.

METHODS

A nutrition-care bundle emphasizing the prompt initiation of parenteral nutrition at birth, initiation of enteral feeds within 6 h after birth, and early addition of human milk fortifiers was implemented in 2015 for infants born < 26 weeks gestation. This before-and-after study evaluated growth and neurodevelopmental outcomes in infants born between 2012-2013 (before-nutrition-bundle, BNB) and 2016-2017 (after-nutrition-bundle, ANB).

RESULTS

A total of 145 infants were included in the study. Infants in the ANB group (n = 73) were smaller (birthweight and gestational age), and there were more male infants and multiples included compared to the BNB group (n = 72). Enteral feeds and fortifiers started earlier in the ANB group. Growth velocity and weight z-score changes were similar in both groups during NICU stay and post-discharge. Systemic steroid use, but not cohort, was linked to lower Bayley scores across all domains.

CONCLUSIONS

Implementing a nutrition-care bundle was not consistently associated with improved weight gain and neurodevelopmental outcomes in the micro-preterm infant population, possibly due to ongoing high-quality nutritional care by the clinical team.

Dilemmas in human milk fortification

Fortification of human milk is the standard of care for very low birth weight (VLBW) infants and is required to support adequate postnatal growth and development. Achieving adequate growth velocity and preventing growth faltering is critical for the developing neonatal brain and optimizing long-term neurodevelopmental outcomes. Mother's milk is the gold standard nutrition to feed preterm infants, however, it does not provide the nutrients needed to support the growth of VLBW infants. After the decision is made to use mother's milk (if available) or alternatively, donor human milk, many dilemmas exist with regards to additional treatment decisions surrounding the type of fortification to use, when to fortify, and the duration of fortification. In this article, we will review the differences in mother's milk compared to donor milk, the different types of human milk fortifiers, the optimal timing of fortification, and discuss when to discontinue human milk fortification.

Context Aware Convolutional Neural Network for Children Caries Diagnosis on Dental Panoramic Radiographs

The objective of this study is to improve traditional convolutional neural networks for more accurate children dental caries diagnosis on panoramic radiographs. A context aware convolutional neural network (CNN) is proposed by considering information among adjacent teeth, based on the fact that caries of teeth often affects each other due to the same growing environment. Specifically, when performing caries diagnosis on a tooth, information from its adjacent teeth will be collected and adaptively fused for final classification. Children panoramic radiographs of 210 patients with one or more caries and 94 patients without caries are utilized, among which there are a total of 6028 teeth with 3039 to be caries. The proposed context aware CNN outperforms typical CNN baseline with the accuracy, precision, recall, F1 score, and area-under-the-curve (AUC) being 0.8272, 0.8538, 0.8770, 0.8652, and 0.9005, respectively, showing potential to improve typical CNN instead of just copying them in previous works. Specially, the proposed method performs better than two five-year attending doctors for the second primary molar caries diagnosis. Considering the results obtained, it is beneficial to promote CNN based deep learning methods for assisting dentists for caries diagnosis in hospitals.