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Human milk-derived fortifiers are linked with feed extension due to Hypoglycemia in infants <1250 g or <30 weeks: a matched retrospective chart review



To investigate differences in hypoglycemia and extended feed prescriptions among premature infants provided bovine-derived human milk fortifiers (Bov-fort) with mother’s milk or formula vs human milk-derived human milk fortifiers (HM-fort) with mother’s milk or donor human milk.

Study design

This was a retrospective chart review (n = 98). Infants receiving HM-fort were matched with infants receiving Bov-fort. Blood glucose values and feed orders were retrieved from the electronic medical record.


Prevalence of ever having blood glucose <60 mg/dL was 39.1% in the HM-fort group vs. 23.9% in the Bov-fort group (p = 0.09). Blood glucose ≤45 mg/dL occurred in 17.4% of HM-fort vs 4.3% in Bov-fort (p = 0.07). Feeds were extended for any reason in 55% of HM-fort vs. 20% of Bov-fort (p < 0.01). Feed extension due to hypoglycemia occurred in 24% of HM-fort vs. 0% of Bov-fort (p < 0.01).


Predominately HM-based feeds are associated with feed extension due to hypoglycemia. Prospective research is warranted to elucidate underlying mechanisms.

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Fig. 1: Percentage of infants requiring any feed extension.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.


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This project was supported by the University of Rochester CTSA award number UL1 TR002001 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations



The following authors contributed significantly to the study conception and design: DA, CD, JM, BY; data collection: DA, BY; analysis and interpretation of results: DA, HW, BY; and draft manuscript preparation: DA, HW, BY. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Danielle Ackley.

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The authors declare no competing interests.


This retrospective chart review was granted exempt status by the University of Rochester Institutional Review Board (study ID: STUDY00006172).

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Ackley, D., Wang, H., D’Angio, C.T. et al. Human milk-derived fortifiers are linked with feed extension due to Hypoglycemia in infants <1250 g or <30 weeks: a matched retrospective chart review. J Perinatol 43, 624–628 (2023).

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