Background: Breastfeeding promotes healthy growth in very-preterm-born infants (VPI), but extra nutritional supply is needed to ensure catch-up growth and brain development. Objectives: To investigate how different types of post-discharge nutrition affect growth until 6 years of age in children born VPI. Methods: This was a 6-year follow-up study of 281 VPI. Median gestational age (GA) was 30 + 0 weeks (range 24–32 weeks). When breastfed at discharge, they were randomized to unfortified human milk (UHM) or fortified human milk (FHM). If not breastfed at discharge, they received a preterm formula (PF). The intervention lasted until 4 months of corrected age (CA). At 6 years CA, their height and weight were measured. Results: A total of 239 children participated in the follow-up. UHM-feeding compared to both PF- and FHM-feeding resulted in a slower but continuous catch-up growth until 6 years of age. Participants born small-for-GA compared to appropriate-for-GA more often demonstrated continuous catch-up growth until 6 years of age (p = 0.018). Rapid weight growth (a change in z score > 1 SD during a short time period) was found to be most pronounced from 34 weeks post-menstrual age to 2 months CA, and especially among those fed PF (p = 0.002 vs. UHM, p = 0.07 vs. FHM). Conclusions: Catch-up growth occurred mainly before discharge, regardless of the feeding group. UHM-fed infants demonstrated catch-up growth that was slower, but extended until 6 years of age. Rapid weight growth was most pronounced shortly after discharge and especially if PF-fed.

Tudehope DI: Human milk and the nutritional needs of preterm infants. J Pediatr 2013; 162:S17–S25.
Cole TJ, Statnikov Y, Santhakumaran S, Pan H, Modi N: Birth weight and longitudinal growth in infants born below 32 weeks’ gestation: a UK population study. Arch Dis Child Fetal Neonatal Ed 2014; 99:F34–F40.
Moro GE, Arslanoglu S, Bertino E, Corvaglia L, Montirosso R, Picaud JC, et al: XII. Human milk in feeding premature infants: consensus statement. J Pediatr Gastroenterol Nutr 2015; 61(suppl 1):S16–S19.
Guellec I, Lapillonne A, Marret S, Picaud JC, Mitanchez D, Charkaluk ML, et al: Effect of intra- and extrauterine growth on long-term neurologic outcomes of very preterm infants. J Pediatr 2016; 175: 93–99.e91.
Kerkhof GF, Willemsen RH, Leunissen RW, Breukhoven PE, Hokken-Koelega AC: Health profile of young adults born preterm: negative effects of rapid weight gain in early life. J Clin Endocrinol Metabol 2012; 97: 4498–4506.
Rochow N, Fusch G, Choi A, Chessell L, Elliott L, McDonald K, et al: Target fortification of breast milk with fat, protein, and carbohydrates for preterm infants. J Pediatr 2013; 163: 1001–1007.
Zachariassen G, Faerk J, Grytter C, Esberg BH, Hjelmborg J, Mortensen S, et al: Nutrient enrichment of mother’s milk and growth of very preterm infants after hospital discharge. Pediatrics 2011; 127:e995–e1003.
Cooke RJ, Embleton ND, Griffin IJ, Wells JC, McCormick KP: Feeding preterm infants after hospital discharge: growth and development at 18 months of age. Pediatr Res 2001; 49: 719–722.
Teller IC, Embleton ND, Griffin IJ, van Elburg RM: Post-discharge formula feeding in preterm infants: a systematic review mapping evidence about the role of macronutrient enrichment. Clin Nutr 2016; 35: 791–801.
Zachariassen G, Fenger-Gron J, Hviid MV, Halken S: The content of macronutrients in milk from mothers of very preterm infants is highly variable. Dan Med J 2013; 60:A4631.
Zachariassen G, Faerk J, Grytter C, Esberg B, Juvonen P, Halken S: Factors associated with successful establishment of breastfeeding in very preterm infants. Acta Paediatr 2010; 99: 1000–1004.
Cormack BE, Embleton ND, van Goudoever JB, Hay WW Jr, Bloomfield FH: Comparing apples with apples: it is time for standardized reporting of neonatal nutrition and growth studies. Pediatr Res 2016; 79: 810–820.
Niklasson A, Albertsson-Wikland K: Continuous growth reference from 24th week of gestation to 24 months by gender. BMC Pediatr 2008; 8: 8.
Tinggaard J, Aksglaede L, Sorensen K, Mouritsen A, Wohlfahrt-Veje C, Hagen CP, et al: The 2014 Danish references from birth to 20 years for height, weight and body mass index. Acta Paediatr 2014; 103: 214–224.
Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al: Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50: 85–91.
Rigo J, Senterre T: Intrauterine-like growth rates can be achieved with premixed parenteral nutrition solution in preterm infants. J Nutr 2013; 143: 2066s–2070s.
Yesinel S, Aldemir EY, Kavuncuoglu S, Yesinel S, Yildiz H: Evaluation of growth in very low birth weight preterm babies. Turk Pediatri Arsivi 2014; 49: 289–298.
El Sakka A, El Shimi MS, Salama K, Fayez H: Post discharge formula fortification of maternal human milk of very low birth weight preterm infants: an introduction of a feeding protocol in a university hospital. Pediatr Rep 2016; 8: 6632.
Arslanoglu S, Moro GE, Ziegler EE: Adjustable fortification of human milk fed to preterm infants: does it make a difference? J Perinatol 2006; 26: 614–621.
Ejlerskov KT, Christensen LB, Ritz C, Jensen SM, Molgaard C, Michaelsen KF: The impact of early growth patterns and infant feeding on body composition at 3 years of age. Br J Nutr 2015; 114: 316–327.
Embleton ND, Korada M, Wood CL, Pearce MS, Swamy R, Cheetham TD: Catch-up growth and metabolic outcomes in adolescents born preterm. Arch Dis Child 2016; 101: 1026–1031.
Fewtrell MS: Growth and nutrition after discharge. Semin Neonatol 2003; 8: 169–176.
Pierrat V, Marchand-Martin L, Guemas I, Matis J, Burguet A, Picaud JC, et al: Height at 2 and 5 years of age in children born very preterm: the EPIPAGE study. Arch Dis Child Fetal Neonatal Ed 2011; 96:F348–F354.
Lucas A, Fewtrell MS, Davies PS, Bishop NJ, Clough H, Cole TJ: Breastfeeding and catch-up growth in infants born small for gestational age. Acta Paediatr 1997; 86: 564–569.
Knops NB, Sneeuw KC, Brand R, Hille ET, den Ouden AL, Wit JM, Verloove-Vanhorick SP: Catch-up growth up to ten years of age in children born very preterm or with very low birth weight. BMC Pediatr 2005; 5: 26.
Quinlivan J, Kua S, Gibson R, McPhee A, Makrides MM: Can we identify women who initiate and then prematurely cease breastfeeding? An Australian multicentre cohort study. Int Breastfeed J 2015; 10: 16.
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