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Individualized Milk Fortification Shows No Growth Benefit For Preterm Infants

Parents of preterm babies want to know if a fancy bedside milk test beats standard NICU fortification, and this five-year trial says no.

By Dr. Axe Editorial Team · September 19, 2026 · 1 source · Watch

A randomized trial published September 14, 2026, in JAMA Pediatrics found that using bedside milk analysis to individually target protein and fat fortification for very preterm infants produced no measurable growth, body-composition, or brain-development advantage over standard fortification, among 130 infants followed through NICU discharge.

130Preterm Infants

5-YearNICU Trial

The single-center, double-blind trial enrolled infants born at 24 to 30 weeks' gestation between February 2020 and March 2025, randomizing 130 infants evenly into two groups of 65. Average gestational age was 28.5 weeks and birth weight 1,165 grams. The intervention group received extra protein and fat only when a handheld milk analyzer showed base milk below 1 gram per deciliter of true protein or 67 kilocalories per deciliter of energy; controls received standard commercial fortifier plus a protein additive for growth faltering. Of the 130 infants, 113 (87%) completed the diet through 36 weeks' postmenstrual age. Measured protein content and total intake were unexpectedly higher in the control group (1.24 g/dL and 4.58 g/kg/day) than the intervention group (1.18 g/dL and 4.47 g/kg/day). Researchers found no evidence of a difference between groups in weight, length, or head circumference z-scores, fat-free mass, or brain MRI measurements near term-equivalent age.

Both groups' milk intakes met or exceeded recommended nutrient targets regardless of which fortification strategy was used, the authors note, which likely explains why individualized targeting added no detectable advantage. Preterm infants receive fortified human milk because breast milk's protein and calorie content varies feeding to feeding and typically falls short of what a fast-growing premature body needs; standard fortification recipes are built to close that gap without measuring each batch.

Total Protein Intake: 4.58 vs 4.47 g/kg/day, No Growth Difference Found

JAMA Pediatrics, 2026

The trial ran at a single academic NICU, and the control group unexpectedly ended up with higher measured protein content and intake than the targeted group, which complicates any read on what precise fortification would have looked like. The outcomes measured were growth and body-composition markers rather than long-term developmental outcomes, and funding was not reported in the abstract.

Dr. Axe’s Take

Standard fortification protocols in a well-run NICU already push preemies well above minimum protein and calorie targets, and this trial shows that adding a bedside milk analyzer to fine-tune dosing further did not move the needle on growth, body composition, or brain measurements. If I had a baby in the NICU, I would not push for specialized milk analysis. I would put my energy into keeping my own milk supply strong through frequent pumping and skin-to-skin contact, and into working with the NICU dietitian on the fortification protocol already in place. Mother's own milk carries immune and hormonal components no fortifier replicates, and that is worth protecting even when a bedside test says nothing more is needed.

— Dr. Axe

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Study summary

Who: 130 very preterm infants born at 24-30 weeks' gestation, mean gestational age 28.5 weeks, mean birth weight 1,165 g; randomized 65 to control and 65 to intervention at a single academic NICU.
Design: Double-blind randomized controlled trial comparing individually targeted human milk fortification, guided by bedside milk analysis, versus standard-of-care fortification; enrolled February 2020 to March 2025, outcomes tracked through NICU discharge and 36 weeks' postmenstrual age.
Dose: Intervention added extra protein and/or fat when base milk analysis showed less than 1 g/dL true protein or 67 kcal/dL energy; control used standard commercial fortifier plus protein additive when growth faltered.
Primary result: No evidence of a difference between groups in weight, length, or head circumference z-scores, fat-free mass, or brain MRI measurements; 113 of 130 infants (87%) completed the study diet.
Secondary: Control group unexpectedly had higher measured milk protein (1.24 g/dL vs 1.18 g/dL) and higher total protein intake (4.58 vs 4.47 g/kg/day) than the intervention group; both groups met or exceeded recommended nutrient intake targets.
Funding / conflicts: Funding not reported in the abstract. Conflicts declared in the PubMed record: one author reported grants from the US National Institute of Child Health and Human Development during the study; another reported speaker fees from the Abbott Nutrition Health Institute outside this work.
Date: Sep 14, 2026