2.3.2. Intervention Description
Milk, breast milk
After reaching 80 mL/kg/day of enteral feeding, patients were randomized to receive SF (Bebilon HMF, NutriciaOne of the researchers (JSS) performed milk analysis in the NICU research laboratory at Princess Anna Mazowiecka Hospital three times per week (Monday/Wednesday/Friday) at 10:00 am and after protocol amendment twice per week (Tuesday/Thursday) from batches collected from the two previous days. A 10 mL aliquot from each batch of native breast milk was used for macronutrient analysis (Miris The mean of three measurements per batch (3 × 2–3 mL) was used to calculate the required amount of extra fat, protein, and carbohydrate for the following three days of fortification using a predefined Excel spreadsheet (Microsoft Inc., Redmond, Washington, USA). Milk analysis was performed for both treatment arms; however, only the intervention group received TF.The desired macronutrient concentration in breast milk was 4.4 g/100 mL of fat, 3 g/100 mL of protein, and 8.8 g/ 100 mL of carbohydrate to meet the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines (6.6 g/kg/d of fat, 4.5 g/kg/d of protein, and 13.2 g/kg/d of carbohydrate) assuming an intake of 150 mL/kg/d. Target fortification was conducted in three steps: Determination of macronutrient concentration in OMM/HDM. SF: Human milk fortifier, HMF NutriciaTF: Adding fat, protein, or carbohydrates to achieve the target levels of macronutrients. In cases where the macronutrient component after SF exceeded the target value, only other deficient macronutrient components were adjusted.The patients were fed every 3 h via a gastric tube by RNs. Starting at 33 weeks of postconceptional age (PCA), non-nutritive sucking stimulation was initiated by occupational therapists. At approximately 34 weeks of PCA, infants transitioned to bottle feeding. When breastfeeding was established, patients received TF as one or two bottled feeds.As a safety assessment to ensure that an appropriate amount of fortifier was added, the osmolality of unfortified and FBM samples was measured using a 3320 Micro-Osmometer (Advance Instruments, Norwood, MA, USA). Bedside nurses were informed whether the osmolality of fortified milk was within the acceptable target range (400–600 mOsmol/kg) before milk was administered during the next 12-h shift. Osmolality lower or higher than the defined target range was considered a sample preparation error of fortification, and the single-nutrient fortification was omitted. TF prescription was completed before noon. The attending physician approved this prescription. Subsequently, individual additives were provided by the nutrition services. Bedside nurses prepared batches of FBM, including additives for target fortification, and divided them into single feeding portions to be administered to infants [The intervention continued until 37 weeks of PCA or hospital discharge. The parents, attending physicians, and outcome assessors were blinded to the interventions.