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Individualized Fortification of Human Milk for Infants Born ≤ 1250 g (MaxiMoM-InForM)

Very Low Birth Weight Infant

Very low birth weight infants have increased nutritional needs. Extra nutrients are added to their human milk feeds to help improve their nutritional status, growth and neurodevelopment. Standard fortification of human milk is routine in most neonatal units in North America, but despite the added nutrients, infants are often discharged from hospitals with poor growth, and their neurodevelopment remains suboptimal. Two individualized fortification methods, target and BUN adjustable, have been proposed to improve the nutrient supply to infants. However, there is currently insufficient evidence to support the implementation of individualized fortification or one method over the other. Therefore, this study will randomly assign very low birth weight infants to receive feeds fortified according to standard, target or BUN adjustable fortification methods until 36 weeks gestational age or hospital discharge whichever occurs first. Feedings will be prepared in milk preparation rooms to ensure caregivers and outcomes assessor remain blinded to feeding allocation. Growth, morbidities, and nutrient intakes will be determined throughout hospitalization and skinfolds assessed at 36 weeks. At 4 months CA, growth and body composition will be determined by air displacement plethysmography and processing speed by electroencephalography on a subset of infants. Neurodevelopment will be assessed using the Bayley Scales of Infant and Toddler Development, at 18-24 months CA.

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Participation Requirements

  • Sex:

    ALL
  • Eligible Ages:

    0 to 21

Participation Criteria

Inclusion Criteria:

* ≤1250 g birth weight.
* Parental/guardian consent to participate.
* Consent for the use of pasteurized donor milk if mother's milk is not available.

Exclusion Criteria:

* Infant received fortifier or formula before Study Day 1.
* Study Day 1 to occur after day 21 of life.
* Infants with congenital or chromosomal anomalies that may affect growth outcome.
* Enrollment in any other clinical study affecting nutritional management during the feeding intervention.
* Reasonable potential that the infant will be transferred to a NICU where the study protocol will not be continued.

Study Location

William Osler Health System-Etobicoke General Hospital
William Osler Health System-Etobicoke General Hospital
Etobicoke, Ontario
Canada

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Southlake Regional Health Centre
Southlake Regional Health Centre
Newmarket, Ontario
Canada

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Mackenzie Health
Mackenzie Health
Richmond Hill, Ontario
Canada

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Sunnybrook Health Sciences Centre
Sunnybrook Health Sciences Centre
Toronto, Ontario
Canada

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University of Toronto
University of Toronto
Toronto, Ontario
Canada

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William Osler Health System-Brampton Civic Hospital
William Osler Health System-Brampton Civic Hospital
Brampton, Ontario
Canada

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Trillium Health Partners-Credit Valley Hospital
Trillium Health Partners-Credit Valley Hospital
Mississauga, Ontario
Canada

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Lakeridge Health
Lakeridge Health
Oshawa, Ontario
Canada

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Michael Garron Hospital
Michael Garron Hospital
Toronto, Ontario
Canada

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The Hospital for Sick Children
The Hospital for Sick Children
Toronto, Ontario
Canada

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Markham Stouffville Hospital
Markham Stouffville Hospital
Markham, Ontario
Canada

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North York General Hospital
North York General Hospital
North York, Ontario
Canada

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Scarborough Health Network-Centenary Hospital
Scarborough Health Network-Centenary Hospital
Scarborough, Ontario
Canada

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Unity Health Toronto-St Michaels Hospital
Unity Health Toronto-St Michaels Hospital
Toronto, Ontario
Canada

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Unity Health Toronto-St Josephs Health Centre
Unity Health Toronto-St Josephs Health Centre
Toronto, Ontario
Canada

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University of Alberta
University of Alberta
Edmonton, Alberta
Canada

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Trillium Health Partners-Missisauga Hospital
Trillium Health Partners-Missisauga Hospital
Mississauga, Ontario
Canada

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Humber River Hospital
Humber River Hospital
North York, Ontario
Canada

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Scarborough Health Network-General Hospital
Scarborough Health Network-General Hospital
Scarborough, Ontario
Canada

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Sinai Health System-Mount Sinai Hospital
Sinai Health System-Mount Sinai Hospital
Toronto, Ontario
Canada

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Study Sponsored By
The Hospital for Sick Children
Participants Required
More Information
Study ID: NCT05308134