Hindmilk and weight gain in preterm very low-birthweight infants

Background: Feeding of own mother's milk to preterm very low-birthweight infants often results in suboptimal weight gain in these infants for whom energy requirements are high but in whom volume tolerance is limited. Therefore the purpose of the present paper was to investigate the effect of selective hindmilk feeding on the growth of preterm very low-birthweight babies. Methods: Preterm very low-birthweight babies admitted into the Special Care Baby Unit of the Jos University Teaching Hospital, Nigeria between April 2000 and July 2001 were randomized to hindmilk and composite breast milk feeding for 2 weeks. End-points were weight, occipitofrontal head circumference and length. Results: For small-for-gestational-age babies, the infants fed on hindmilk gained weight at a mean rate of 12.92 +/- 10.95 g/kg per day as compared with a mean rate of 5.01 +/- 17.37 g/kg per day for their controls on composite milk (P < 0.0001). For appropriate-for-gestational-age babies, the mean rate of weight gain for the hindmilk group was 12.99 +/- 10.75 g/kg per day while that for their controls on composite milk was 8.29 +/- 20.56 g/kg per day (P < 0.01). There were no significant differences in the rates of increase in length and occipitofrontal head circumference between the groups. The lipid content of the hindmilk was 1.6-fold that of composite milk. Conclusion: Preterm very low-birthweight babies fed hindmilk had a higher rate of weight gain compared to those fed composite milk. It is recommended that the hindmilk fraction of expressed breast milk be predominantly used for the feeding of preterm very low-birthweight babies while in hospital to help shorten their duration of hospital stay.