Background: Nutrition is an important aspect in the care of very low birth weight (VLBW) preterm infants. Human milk
fortified with human milk fortifiers (HMF) is best for enteral feeding of premature infants. HMF is expensive and not easily available in Thailand. Post discharge formula (PDF) has been routinely used to fortify human milk at Queen Sirikit National Institute of Child Health (QSNICH) but there is lack of supportive data regarding efficacy and safety.
Objective: To study and compare anthropometrics, biochemical markers and complications in VLBW infants fed human milk fortified with either HMF or PDF.
Material and Method: This was a prospective, randomized pilot study conducted in the neonatal unit of QSNICH from 1 March 2010 to 28 February 2011. Very low birth weight neonates, whose mothers had adequate breast milk within 96 hours of birth, were enrolled in the study and received parenteral nutrition and enteral feeding as per protocol. Once the babies were feeding 100 cc/kg/day of human milk, they were randomly divided into two groups: the human milk fortified group (HMF group) and the post discharge formula fortified group (PDF group). Body weight was recorded daily while head circumference and length were recorded weekly. Hematocrit, Blood Urea Nitrogen (BUN), creatinine, electrolytes (including phosphorus and calcium), alkaline phosphatase and albumin were checked at the beginning of the study (feeding 100 cc/kg/day), 3 weeks later and when on full oral breast feeding or reached a weight of 2,000 grams, which ever came first.
Results: Thirty-eight infants were enrolled in the study but eventually only 33 remained (18 in HMF group, 15 in PDF group). Both groups had similar baseline demographic data, nutritional management, postnatal morbidities and length of stay. There were no statistically significant differences in growth parameters and serum biochemical markers between the groups. Definite NEC was not different between the groups. Other complications of prematurity including osteopenia of prematurity were similar in both the groups. The cost of breast milk fortification per person in the PDF and HMF group was 605 and 11,655 baht, respectively.
Conclusion: Human milk fortifiers are best for fortification of human milk in VLBW babies but using PDF as a fortifier may be considered as an alternative for VLBW infant in resource limited, developing countries. However, it should always be additionally supplemented with multivitamins especially vitamin D, iron, calcium and phosphorus. Complications like feeding intolerances and suspected NEC should be monitored closely. Larger studies focusing on short and long-term outcomes are needed in the future.

Keywords: Human milk, Human milk fortifier, Post-discharge formula