University of Washington
The goal of the trial is to learn if targeted sodium supplementation (including blood and urine sodium testing) versus standard milk fortification (including blood sodium testing) improves growth and body composition in very preterm infants?
Very preterm infants (born \<32 weeks gestational age) are at high risk for postnatal growth faltering, which is associated with adverse neurodevelopmental outcomes. Despite routine use of enriched human milk fortification in the NICU, many infants fail to achieve adequate somatic and lean mass growth. Sodium depletion has been identified as a potentially modifiable contributor to this problem: renal tubular immaturity in preterm infants results in obligate urinary sodium wasting. Total body sodium depletion has been associated with poor growth in infants and poor muscle mass development in an…
Inclusion Criteria: * Admitted to the University of Washington, Oregon Health and Sciences, or University of Cincinnati NICU at 14 days of age * Born between 24w0days and 31w6d * Achieved full enteral feeding Exclusion Criteria: * Congenital or chromosomal anomalies affecting growth * Acute renal insufficiency (KDIGO stage 1 or higher) * Necrotizing enterocolitis (modified Bell's stage IIA or higher) * Anticipated NICU stay less than 30 days * Enrollment in a concurrent interventional study that may confound study outcomes
The investigators will utilize urine sodium testing every two weeks in conjunction with serum sodium testing to determine if sodium supplementation is indicated.
The investigators will use serum sodium testing to determine if sodium supplementation or adjustments to sodium supplementation need to be made.
The investigators will provide milk fortification using either a bovine-based or a human-milk-based fortifier (per unit protocol), based on growth trajectories.
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