{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:08:42Z","timestamp":1792084122864,"version":"4.4.0"},"reference-count":47,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,6,1]]},"abstract":"\n Background.<\/jats:title>\n In a large-scale study of feeding strategies in premature infants (early vs later initiation of enteral feeding, continuous vs bolus tube-feeding, and human milk vs formula), the feeding of human milk had more effect on the outcomes measured than any other strategy studied. Therefore, this report describes the growth, nutritional status, feeding tolerance, and health of participating premature infants who were fed fortified human milk (FHM) in comparison with those who were fed exclusively preterm formula (PF).<\/jats:p>\n <\/jats:sec>\n \n Methods.<\/jats:title>\n Premature infants were assigned randomly in a balanced two-way design to early (gastrointestinal priming for 10 days) versus late initiation of feeding (total parenteral nutrition only) and continuous infusion versus intermittent bolus tube-feeding groups. The type of milk was determined by parental choice and infants to receive their mother's milk were randomized separately from those to receive formula. The duration of the study spanned the entire hospitalization of the infant. To evaluate human milk versus formula feeding, we compared outcomes of infants fed &gt;50 mL\u2009\u00b7\u2009kg\u22121\u2009\u00b7\u2009day\u22121 of any human milk (averaged throughout the hospitalization) with those of infants fed exclusively PF. Growth, feeding tolerance, and health status were measured daily. Serum indices of nutritional status were measured serially, and 72-hour nutrient balance studies were conducted at 6 and 9 weeks postnatally.<\/jats:p>\n <\/jats:sec>\n \n Results.<\/jats:title>\n A total of 108 infants were fed either &gt;50 mL\u2009\u00b7\u2009kg\u22121\u2009\u00b7\u2009day\u22121 human milk (FHM,n = 62) or exclusively PF (n = 46). Gestational age (28 \u00b1 1 weeks each), birth weight (1.07 \u00b1 0.17 vs 1.04 \u00b1 0.19 kg), birth length and head circumference, and distribution among feeding strategies were similar between groups. Infants fed FHM were discharged earlier (73 \u00b1 19 vs 88 \u00b1 47 days) despite significantly slower rates of weight gain (22 \u00b1 7 vs 26 \u00b1 6 g\u2009\u00b7\u2009kg\u22121\u2009\u00b7\u2009day\u22121), length increment (0.8 \u00b1 0.3 vs 1.0 \u00b1 0.3 cm\u2009\u00b7\u2009week\u22121), and increment in the sum of five skinfold measurements (0.86 \u00b1 0.40 vs 1.23 \u00b1 0.42 mm\u2009\u00b7\u2009week\u22121) than infants fed PF. The incidence of necrotizing enterocolitis and late-onset sepsis was less in the FHM group. Overall, there were no differences in any measure of feeding tolerance between groups. Milk intakes of infants fed FHM were significantly greater than those fed PF (180 \u00b1 13 vs 157 \u00b1 10 mL\u2009\u00b7\u2009kg\u22121\u2009\u00b7\u2009day\u22121). The intakes of nitrogen and copper were higher and magnesium and zinc were lower in group FHM versus PF. Fat and energy absorption were lower and phosphorus, zinc, and copper absorption were higher in group FHM versus PF. The postnatal retention (balance) surpassed the intrauterine accretion rate of nitrogen, phosphorus, magnesium, zinc, and copper in the FHM group, and of nitrogen, magnesium, and copper in the PF group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions.<\/jats:title>\n Although the study does not allow a comparison of FHM with unfortified human milk, the data suggest that the unique properties of human milk promote an improved host defense and gastrointestinal function compared with the feeding of formula. The benefits of improved health (less sepsis and necrotizing enterocolitis) associated with the feeding of FHM outweighed the slower rate of growth observed, suggesting that the feeding of FHM should be promoted actively in premature infants.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.103.6.1150","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T19:45:45Z","timestamp":1092426345000},"page":"1150-1157","source":"Crossref","is-referenced-by-count":570,"title":["Feeding Strategies for Premature Infants: Beneficial Outcomes of Feeding Fortified Human Milk Versus Preterm Formula"],"prefix":"10.1542","volume":"103","author":[{"given":"Richard J.","family":"Schanler","sequence":"first","affiliation":[{"name":"From the Children's Nutrition Research Center and Sections of"},{"name":"Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Shulman","sequence":"additional","affiliation":[{"name":"From the Children's Nutrition Research Center and Sections of"},{"name":"Pediatric Gastroenterology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Lau","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[1999,6,1]]},"reference":[{"key":"2021121000392027600_B1","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1542\/peds.100.6.1035","article-title":"Breastfeeding and the use of human milk.","volume":"100","author":"American Academy of Pediatrics, Work Group on Breastfeeding","year":"1997","journal-title":"Pediatrics."},{"key":"2021121000392027600_B2","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0095-5108(18)30309-9","article-title":"Suitability of human milk for the low birthweight infant.","volume":"22","author":"Schanler","year":"1995","journal-title":"Clin Perinatol."},{"key":"2021121000392027600_B3","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/S0022-3476(83)80302-3","article-title":"Macromineral balances in premature infants fed their own mothers' milk or formula.","volume":"102","author":"Atkinson","year":"1983","journal-title":"J Pediatr."},{"key":"2021121000392027600_B4","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1136\/adc.62.9.917","article-title":"Human milk and preterm formula compared for effects on growth and metabolism.","volume":"62","author":"Brooke","year":"1987","journal-title":"Arch Dis Child."},{"key":"2021121000392027600_B5","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/00005176-198411000-00020","article-title":"Growth and biochemical response of premature infants fed pooled preterm milk or special formula.","volume":"3","author":"Cooper","year":"1984","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"2021121000392027600_B6"},{"key":"2021121000392027600_B7","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1136\/adc.52.4.296","article-title":"Adequacy of expressed breast milk for early growth of preterm infants.","volume":"52","author":"Davies","year":"1977","journal-title":"Arch Dis Child."},{"key":"2021121000392027600_B8","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/ajcn\/52.2.254","article-title":"Growth, nutrient retention, and metabolic response of low-birth-weight infants fed supplemented and unsupplemented preterm human milk.","volume":"52","author":"Kashyap","year":"1990","journal-title":"Am J Clin Nutr."},{"key":"2021121000392027600_B9","first-page":"671","article-title":"Decreased morbidity in preterm neonates fed their own mothers' milk.","volume":"49","author":"Contreras-Lemus","year":"1992","journal-title":"Biol Med Hosp Infant Mex."},{"key":"2021121000392027600_B10","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00005176-198605020-00014","article-title":"Pooled pasteurized breast milk and untreated own mother's milk in the feeding of very low birth weight babies: a randomized controlled trial.","volume":"5","author":"Stein","year":"1986","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"2021121000392027600_B11","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1056\/NEJM197902083000607","article-title":"Nutritional hypophosphatemic rickets in a premature infant fed breast milk.","volume":"300","author":"Rowe","year":"1979","journal-title":"N Engl J Med."},{"key":"2021121000392027600_B12","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1136\/adc.64.7_Spec_No.902","article-title":"High alkaline phosphatase activity and growth in preterm neonates.","volume":"64","author":"Lucas","year":"1989","journal-title":"Arch Dis Child."},{"key":"2021121000392027600_B13","first-page":"329","article-title":"Body composition of the reference fetus.","volume":"40","author":"Ziegler","year":"1976","journal-title":"Growth."},{"key":"2021121000392027600_B14","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/S0022-3476(88)80227-0","article-title":"Improved bone mineralization and growth in premature infants fed fortified own mother's milk.","volume":"112","author":"Greer","year":"1988","journal-title":"J Pediatr."},{"key":"2021121000392027600_B15","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1542\/peds.77.5.649","article-title":"Supplementation with human milk protein improves growth of small premature infants fed human milk.","volume":"77","author":"Ronnholm","year":"1986","journal-title":"Pediatrics."},{"key":"2021121000392027600_B16","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1542\/peds.100.2.240","article-title":"The effects of nutrient fortification and varying storage conditions on host defense properties of human milk.","volume":"100","author":"Jocson","year":"1997","journal-title":"Pediatrics."},{"key":"2021121000392027600_B17","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/000992289403300602","article-title":"The effect of nutritional additives on anti-infective factors in human milk.","volume":"33","author":"Quan","year":"1994","journal-title":"Clin Pediatr."},{"key":"2021121000392027600_B18","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1093\/ajcn\/64.2.142","article-title":"Randomized outcome trial of human milk fortification and developmental outcome in preterm infants.","volume":"64","author":"Lucas","year":"1996","journal-title":"Am J Clin Nutr."},{"key":"2021121000392027600_B19","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1093\/ajcn\/64.2.249","article-title":"Human milk fortification for premature infants.","volume":"64","author":"Schanler","year":"1996","journal-title":"Am J Clin Nutr."},{"key":"2021121000392027600_B20","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1542\/peds.103.2.434","article-title":"Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method.","volume":"103","author":"Schanler","year":"1999","journal-title":"Pediatrics."},{"key":"2021121000392027600_B21"},{"key":"2021121000392027600_B22","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1542\/peds.102.2.411","article-title":"Hospital discharge of the high-risk neonate: proposed guidelines.","volume":"102","author":"American Academy of Pediatrics, Committee on Fetus and Newborn","year":"1998","journal-title":"Pediatrics."},{"key":"2021121000392027600_B23","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/j.1552-6909.1998.tb02616.x","article-title":"Growth and development of a hospital-based lactation program and mother's own milk bank.","volume":"27","author":"Hurst","year":"1998","journal-title":"J Obstet Gynecol Neonatal Nurs."},{"key":"2021121000392027600_B24","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S0022-3476(95)70465-5","article-title":"Postnatal attainment of intrauterine macromineral accretion rates in low birth weight infants fed fortified human milk.","volume":"126","author":"Schanler","year":"1995","journal-title":"J Pediatr."},{"key":"2021121000392027600_B25","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1203\/00006450-199111000-00013","article-title":"Short-term measurement of linear growth in preterm infants: validation of a hand-held knemometer.","volume":"30","author":"Michaelsen","year":"1991","journal-title":"Pediatr Res."},{"key":"2021121000392027600_B26","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0022-3476(96)70191-9","article-title":"Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network.","volume":"129","author":"Stoll","year":"1996","journal-title":"J Pediatr."},{"key":"2021121000392027600_B27","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1093\/ajcn\/67.3.465","article-title":"Moderate nutrient supplementation of mother's milk for preterm infants supports adequate bone mass and short-term growth: a randomized, controlled trial.","volume":"67","author":"Wauben","year":"1998","journal-title":"Am J Clin Nutr."},{"key":"2021121000392027600_B28","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/S0022-3476(88)80226-9","article-title":"Bone mineralization in former very low birth weight infants fed either human milk or commercial formula.","volume":"112","author":"Abrams","year":"1988","journal-title":"J Pediatr."},{"key":"2021121000392027600_B29","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/S0022-3476(89)80460-3","article-title":"Bone mineralization in former very low birth weight infants fed either human milk or commercial formula: one year follow-up observation.","volume":"114","author":"Abrams","year":"1989","journal-title":"J Pediatr."},{"key":"2021121000392027600_B30","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/S0022-3476(88)80335-4","article-title":"Improved mineral balance in very low birth weight infants fed fortified human milk.","volume":"112","author":"Schanler","year":"1987","journal-title":"J Pediatr."},{"key":"2021121000392027600_B31","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/S0022-3476(78)81249-9","article-title":"Hyponatremia in very low-birth-weight infants and human milk feedings.","volume":"93","author":"Kumar","year":"1978","journal-title":"J Pediatr."},{"key":"2021121000392027600_B32"},{"key":"2021121000392027600_B33","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1203\/00006450-198904000-00022","article-title":"Growth of very low birth weight infants on varying amounts of human milk protein.","volume":"25","author":"Polberger","year":"1989","journal-title":"Pediatr Res."},{"key":"2021121000392027600_B34","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1203\/00006450-199206000-00009","article-title":"Bone mineralization outcomes in human milk-fed preterm infants.","volume":"31","author":"Schanler","year":"1992","journal-title":"Pediatr Res."},{"key":"2021121000392027600_B35","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/j.1440-1754.1994.tb00661.x","article-title":"How appropriate are commercially available human milk fortifiers?","volume":"30","author":"Metcalf","year":"1994","journal-title":"J Paediatr Child Health."},{"key":"2021121000392027600_B36","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/0140-6736(90)93304-8","article-title":"Breast milk and neonatal necrotizing enterocolitis.","volume":"336","author":"Lucas","year":"1990","journal-title":"Lancet."},{"key":"2021121000392027600_B37","first-page":"130","article-title":"Use of human milk in the intensive care nursery decreases the incidence of nosocomial sepsis.","volume":"17","author":"El-Mohandes","year":"1998","journal-title":"J Perinatol."},{"key":"2021121000392027600_B38"},{"key":"2021121000392027600_B39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM198807073190101","article-title":"Prevention of necrotizing enterocolitis in low-birth-weight infants by IgA-IgG feeding.","volume":"319","author":"Eibl","year":"1988","journal-title":"N Engl J Med."},{"key":"2021121000392027600_B40","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/00005176-198605000-00001","article-title":"Immunologic system in human milk.","volume":"5","author":"Goldman","year":"1986","journal-title":"J Pediatr Gastroenterol Nutr."},{"key":"2021121000392027600_B41","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/BF02018076","article-title":"Bioactive components of milk.","volume":"1","author":"Goldman","year":"1996","journal-title":"J Mammary Gland Biol Neoplasia."},{"key":"2021121000392027600_B42","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1007\/BF01324906","article-title":"The enteromammary immune system.","volume":"24","author":"Kleinman","year":"1979","journal-title":"Dig Dis Sci."},{"key":"2021121000392027600_B43"},{"key":"2021121000392027600_B44","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/S0022-3476(86)80941-6","article-title":"Energy balance in low birth weight infants fed formula of high or low medium-chain triglyceride content.","volume":"108","author":"Whyte","year":"1986","journal-title":"J Pediatr."},{"key":"2021121000392027600_B45","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0022-3476(86)80893-9","article-title":"Fatty acid balance studies in premature infants fed human milk or formula: effect of calcium supplementation.","volume":"108","author":"Chappell","year":"1986","journal-title":"J Pediatr."},{"key":"2021121000392027600_B46","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/BF01956152","article-title":"Nitrogen and fat balances in very low birth weight infants fed human milk fortified with human milk or bovine milk protein.","volume":"152","author":"Boehm","year":"1993","journal-title":"Eur J Pediatr."},{"key":"2021121000392027600_B47","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/j.1651-2227.1969.tb04728.x","article-title":"Balance of net acid in growing infants.","volume":"58","author":"Kildeberg","year":"1969","journal-title":"Acta Paediatr Scand."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/6\/1150\/843356\/1150.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/6\/1150\/843356\/1150.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T02:44:13Z","timestamp":1639104253000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/103\/6\/1150\/62255\/Feeding-Strategies-for-Premature-Infants"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,6,1]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1999,6,1]]},"published-print":{"date-parts":[[1999,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.103.6.1150","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[1999,6,1]]}}}