Evaluating the role of human milk fortifiers in very low birth weight infants: A prospective cohort study

Very low birth weight (VLBW) infants are at heightened risk for postnatal growth failure and neurodevelopmental delays due to inadequate nutrient intake from unfortified human milk. Human milk fortifiers (HMFs) are routinely used to address these deficits, but evidence on their safety and long-term benefits remains mixed. The objective is to evaluate the impact of HMF on growth, feeding tolerance, and early neurodevelopment in VLBW infants in a prospective cohort setting. A total of 100 VLBW infants were enrolled and divided into two groups: those receiving fortified human milk (HMF group) and those receiving unfortified human milk (control group). Primary outcomes included weight gain velocity, length and head circumference growth; secondary outcomes included NEC incidence, feeding intolerance, and Bayley-III cognitive scores at six months corrected age. The HMF group demonstrated significantly higher weight gain (18.4±2.1 vs. 14.2±1.8 g/kg/day, p < 0.001), length gain (1.1±0.3 vs. 0.8±0.2 cm/week, p = 0.002), and head circumference growth (0.9±0.2 vs. 0.7±0.2 cm/week, p = 0.005) compared to controls. NEC incidence and feeding intolerance did not differ significantly between groups. Bayley-III cognitive scores were higher in the HMF group (95±8 vs. 90±10, p = 0.03). Fortification of human milk in VLBW infants is associated with improved growth and early neurodevelopmental outcomes without increasing feeding complications. These findings support routine HMF use in neonatal care and highlight the need for long-term follow-up to evaluate sustained developmental benefits.