Bovine colostrum as a human milk fortifier for very preterm infants with slow feeding advancement: a randomized controlled trial

BACKGROUND: Fortification of human milk for very preterm infants (VPIs) with alternatives to conventional bovine milk-based fortifiers remains minimally studied. This trial tested whether fortification with protein-rich bovine colostrum (BC) improves feeding intolerance and clinical variables in VPIs receiving enteral nutrition with a relatively slow advancement.

METHODS: In this unblinded, two-centre, randomised, controlled trial (FortiColos CN), VPIs (gestational age, 26 + 0 to 31 + 6 weeks) were fed human milk fortified with BC (n = 74) or a conventional fortifier (CF, FM85, Nestlé, n = 72) for at least two weeks, starting when enteral feeding volume reached 80-100 mL/kg body weight/d. Incidence of feeding intolerance, nutrition intake, body growth, morbidities and clinical biochemical parameters were compared between the two groups.

RESULTS: No statistically significant difference was found in the incidence of feeding intolerance or in most of the nutritional or body growth parameters (p > 0.05). All recorded morbidity incidences and haematological and blood biochemical parameters were also similar between groups. Amino acids (Phe, Pro, Ser, Tyr, Val) showed higher levels in the infants receiving BC.

CONCLUSIONS: BC appeared safe when used as a fortifier to human milk for VPIs with slow feeding advancement, but did not improve feeding tolerance or clinical variables.

IMPACT: Fortifying human milk with bovine colostrum (BC) in very preterm infants (VPIs) is safe but did not improve feeding tolerance, growth or clinical outcomes, compared with a conventional fortifier (CF), when used during slow enteral feeding advancement. This study adds to the limited clinical evidence on the use of BC as a human milk fortifier in VPIs receiving enteral feeding with different feeding protocols. The findings support the safety of BC as a human milk fortifier in VPIs but suggest limited short-term clinical benefits over currently used fortifiers.