There is no optimal feeding strategy for most premature infants awaiting breastfeeding.

For preterm infants awaiting the opportunity to breastfeed, none of the common nutritional support methods emerged as a clear winner in a head-to-head comparison in the DIAMOND trial.

For infants born between 32 weeks and 35 weeks and 6 days of gestation, which account for 85% of all premature infants worldwide, the average body fat percentage at 4 months of age when parenteral nutrition is compared with glucose solution were similar (26.0% vs. 26.2%). P=0.72), milk supplements versus breast milk alone (26.3% vs. 25.8%, P=0.25).

Providing infants with taste and smell had no effect on time to full enteral feeding (5.8 days vs. 5.7 days with no exposure). P=0.59), researchers led by Dr. Frank H. Bloomfield of the University of Auckland, New Zealand. New England Medical Journal.

Although the benefits of breastfeeding are well established, researchers say:[m]Moderate to late preterm infants require nutritional support after birth until adequate maternal milk supply and intake is achieved. ”

Practice varies widely as there is no strong evidence or guideline recommendations regarding when and how nutritional support other than breastfeeding should be provided.

Theoretically, the benefits of a nutrient-rich diet would be related to “preventing nitrogen deficiency and protein catabolism,” while providing taste and odor “stimulates the radial phase response, improving gastrointestinal function and food intake.” It is believed that it aids in the metabolic response to “This can shorten the time to full enteral feeding,” Bloomfield’s group noted.

But after finding no difference in early results with DIAMOND, researchers decided to target infants of mothers who intended to breastfeed, even if it took several days for the milk supply to become sufficient. I suggested that it be done elsewhere.

“Our findings support an approach that focuses on providing mothers with the necessary lactation support, thereby maximizing their chances of achieving exclusive breastfeeding,” Bloomfield et al. ing.

The researchers noted that their findings apply to “infants in neonatal nurseries where mothers who intend to breastfeed are provided with dedicated breastfeeding support, as was the case in this study.”

Their DIAMOND (Different Approaches to Moderate and Late Preterm Neonatal Nutrition: Determinants of Feed Tolerance, Body Composition and Development) trial involved infants admitted to neonatal units at five hospitals across New Zealand from 32 weeks 0 days 532 infants born between 35 weeks of age were included6. A few days pregnant, IV access was available for clinical reasons, and the mother intended to breastfeed. Exclusions included newborns with specific nutritional needs or known chromosomal or genetic abnormalities or congenital defects that affect growth, body composition, or neurodevelopment.

The study used a multifactorial design to randomly assign infants within the first 24 hours of life to one of eight possible combinations in a 1:1 ratio.

• Amino acid solutions and IV glucose for parenteral nutrition
• Supplementing milk from donor breast milk or infant formula compared to only breast milk from the infant’s mother as enteral feeding
• Experience the taste and smell of milk before each tube feeding (pour 0.2 mL of milk into the mouth with a syringe just before, and 0.1-0.5 mL of milk on gauze near the nose during feeding) paint)

These interventions were carried out until the mother’s milk supply and intake met the goals defined by the clinical team, with the aim of reaching exclusive maternal breastfeeding as soon as possible. At the clinician’s discretion, IV lipid emulsions may also be administered.

There were no significant interactions between interventions for the primary outcome of mean body fat percentage after 4 months for the parenteral and glucose groups and the milk supplementation and breast milk groups. Similarly, there was no interaction for the primary outcome of time to first full enteral feeding for the taste and smell interventions.

Secondary outcomes were similar across interventions, including body composition characteristics, time to full lactation, time to full enteral feeding, breastfeeding status at discharge and corrected gestational age of 4 months, and length of hospital stay. did. hospital.

One infant had three serious adverse events (necrotizing enterocolitis, gastrointestinal surgery, and death) that were not considered related to the study. The baby was assigned only parenteral nutrition, mother’s breast milk, and no smell or taste interventions.

The overall lack of effect of the intervention on body composition may be due to the short period during which nutritional support was provided, as most infants reach full enteral feeding within the first week of life. “possible,” the researchers suggested. “The lack of clear effects of olfaction and taste exposure in this study may be due to the multiple stimuli in the neonatal intensive care setting, including the large number of odors, which may be associated with the odor of milk. Potential effects of taste may have been overcome.”

Although the large sample size was an advantage, the study was limited by its open-label design and constraints due to the COVID-19 pandemic. Although 85% of the infants were evaluated at 4 months of age, “many of these evaluations were performed in infant homes rather than clinics due to family wishes,” the researchers noted. Still, 61% had assessed her percent fat mass at 4 months, which exceeded the number needed to power the study for the primary endpoint.

Another limitation is that the test evaluates outcomes over a relatively short period of time, Bloomfield et al. write. “Two-year follow-up of infants enrolled in this trial is underway to assess neurodevelopment.”