{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T16:58:01Z","timestamp":1763139481110,"version":"3.44.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Very-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We designed a randomized controlled trial to determine whether an enhanced method of fortification (EF) improved growth in VLBW infants compared to standard fortification (SF). VLBW infants admitted to our tertiary-level neonatal intensive care unit were randomized to receive a bovine powdered human milk fortifier (HMF) added to PDHM (SF), or specially selected high-fat PDHM (fat concentration \u22653.8 g\/dL) with bovine powdered HMF and a liquid protein fortifier providing an additional 0.67 g\/dL protein (EF). Primary outcome was impaired weight gain defined as weight z-score drop of \u22650.8 from birth at 37 weeks or hospital discharge, whichever earlier. Secondary outcomes included change in length and head circumference (HC) z-scores from birth, requirement for high calorie formula, and rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 61 infants were randomized (31 SF, 30 EF). Impaired weight gain was not significantly different (SF 83.9% vs. EF 73.3%, p = 0.347), with similar declines in weight z-scores from birth in both groups SF \u22121.27 [interquartile range (IQR) \u22121.71, \u22120.87] vs. EF \u22121.13 (IQR \u22121.46, \u22120.78), <jats:italic>p<\/jats:italic> = 0.403. However, the EF group had a smaller decline in length and HC z-scores from birth to discharge compared to the SF group [Length z-score change: \u22120.92 (IQR \u22121.64, \u22120.48) vs. \u22121.64 (IQR \u22122.21, \u22120.89), <jats:italic>p<\/jats:italic> = 0.007; HC z-score change: \u22120.08 (IQR \u22120.74,0.58) vs. \u22120.86 (IQR \u22121.81, \u22120.21), <jats:italic>p<\/jats:italic> = 0.014]. The EF group also required less high calorie formula supplementation [0% (IQR 0-4.1) vs. 3.8% (IQR 0 \u221216.9), <jats:italic>p<\/jats:italic> = 0.032]. Rates of BPD and ROP were not significantly different between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among VLBW infants, EF did not improve weight gain, but reduced declines in HC and linear growth compared to SF.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1582519","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T14:58:55Z","timestamp":1755529135000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Chengsi","family":"Ong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anng 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