O3224: Dietary Impact on Growth and Neurodevelopmental Outcomes in Premature Infants After Hospital Discharge

Background: Human milk fortifiers have become standard care for extremely preterm infants in the neonatal intensive care unit (NICU), demonstrating benefits for growth and neurodevelopment when introduced early. However, the impact of continued fortification after NICU discharge remains unclear. With limited evidence on post-discharge dietary regimens and their influence on neurological outcomes, this study aims to evaluate dietary practices after NICU discharge—specifically the use of fortifiers—and their association with growth and neurodevelopment in extremely preterm infants.

Methods: This study is a retrospective chart review, utilizing data from a secure database, comprising approximately 300 premature infants seen at the Neurodevelopment Clinic at Corewell Health East in Royal Oak, Michigan. Data was collected between 2020 and 2025, following infants for up to two years. Of the 300 infants in the database, 175 infants met eligibility criteria, including admission or transfer to a Corewell NICU within the first week of life, presentation to the clinic for their first assessment between two and six months corrected age, and at least one follow-up visit. Infants with intrauterine growth restriction or those discharged with a gastrostomy tube were excluded. Several variables were collected including dietary type, growth parameters, and neurological assessments, such as the Alberta Infant Motor Scale (AIMS) score for gross motor development. Infants were categorized by diet practices between discharge and the first visit, and outcomes were analyzed for differences in growth and neurodevelopment. Statistical analysis included t-tests.

Results: Among the 175 preterm infants, 19 received unfortified human milk, 109 consumed formula, and 47 consumed fortified human milk. Preliminary data shows at 5–7.99 months corrected age, the average weight was similar across groups: 7.0 kg for fortified human milk, 6.9 kg for formula, and 6.9 kg for unfortified human milk. At 11–13.99 months, formula-fed infants had the highest average weight (9.7 kg), followed by human milk (9.6 kg) and fortified human milk (8.8 kg). At 17–19.99 months, formula-fed infants continued to have the highest weight (11.7 kg), compared to 10.6 kg for human milk and 10.1 kg for fortified human milk. There was no statistical significance between the groups at each of the visits. Regarding neurodevelopment, AIMS scores were highest for the human milk group at 5–7.99 months (33.0), 11–13.99 months (55.0), and 17–19.99 months (58.0). Human milk had statistically significant effects on gross motor development in comparison to fortified human milk (p=0.01) and formula (p < 0.001) at the 11-13.99 visit. Statistical analysis is ongoing to determine significance.

Conclusion: Preliminary data illustrates dietary practices do not effect growth outcomes post discharge, while those on human milk may have improved neurological outcomes. These findings will help inform future nutritional interventions for this vulnerable population.