Fat supplementation of human milk for promoting growth in preterm infants.

Systematic review of randomized evidence in preterm infants fed human milk in hospital. The available comparison came from one small Swedish two-center trial in infants born before 32 gestational weeks and weighing less than 1500 grams, without major congenital malformations or other medical problems.

Human milk was supplemented enterally with 1 gram human milk fat per 100 mL of human milk. The intervention began once infants tolerated enteral feeds at 170 mL/kg/day and continued until breastfeeding or body weight reached 2200 g; standard fortification was also used, and the intervention group received vitamins and minerals.

Overall, there is insufficient high-quality evidence to support routine fat supplementation of human milk for preterm infants. One small trial found no clear improvement in short-term growth: weight gain was MD 0.6 g/kg/day, 95% CI -2.4 to 3.6; length gain was MD 0.1 cm/week, 95% CI -0.08 to 0.3; and head circumference gain was MD 0.2 cm/week, 95% CI -0.07 to 0.4. Feeding intolerance was also not clearly increased, with RR 3.00, 95% CI 0.1 to 64.3. No long-term neurodevelopmental or cardio-metabolic outcomes were reported, and the evidence was rated very low quality with wide uncertainty.

Evidence was based on a single very small trial, with only 14 to 16 infants contributing to the reported outcomes. Confidence intervals were very wide, the evidence quality was very low, and no long-term outcomes were reported. Adverse event reporting was limited, and the intervention included co-fortification and added vitamins/minerals, which may limit generalizability to isolated fat supplementation.