Very Preterm InfantNCT07861984
The Use of Early Fortification in Preterm Infants
A study testing Early Fortification and Standard Fortification in people with Very Preterm Infant and Very Low Birth Weight Infants, run by Universitas Indonesia at 1 site in Indonesia.
Trial summary
Very premature or very low birth weight (VLBW) infants are at risk of suboptimal growth after birth, making adequate nutrition essential. Breast milk alone is insufficient to meet the nutritional needs of premature infants, so fortification is added to breast milk to support catch-up growth. Read more about this study
- Who is it for?
- Ages 28 to 32 weeksHealthy volunteers can take part
- Conditions the study is for
- Very Preterm Infant, Very Low Birth Weight Infants
- What is being tested?
- Early Fortification and Standard Fortification
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 44 participants
- Where
- 1 siteIndonesia
- Study dates
- 10 Nov 2024to 30 Jun 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 28 to 32 weeks
- All sexes
- Healthy volunteers accepted
- Child
Who may be able to join
- Very preterm infants (gestational age 28 to <32 weeks) or very low birth weight infants (birth weight 1000 to <1500 grams)
- Infants receiving at least 50% of their daily enteral needs from breast milk
- Infants whose parents provided written informed consent to participate in the study
Who cannot join
- Infants with major congenital abnormalities
- Infants with grade 2 or grade 3 NEC or spontaneous intestinal perforation (SIP) before the intervention
- Infants who had already achieved return to birth weight (RTBW) before initiation of the intervention
- Infants with insufficient breast milk availability to provide ≥50% of their daily enteral requirements before enrollment
- Infants born to mothers with medical conditions that precluded breastfeeding
- Infants with known cow's milk protein allergy before initiation of the intervention
- Infants who died before initiation of the intervention
- Parents who withdrew informed consent
Trial locations and contacts
1 site in 1 country.
Indonesia1 site
Cipto Mangunkusumo Hospital
Jakarta Pusat, DKI Jakarta, 10430
About this study
Official title: Early Fortification to Shorten Birth Weight Recovery Time in Very Preterm or Very Low Birth Weight Infants
Very premature or very low birth weight (VLBW) infants are at risk of suboptimal growth after birth, making adequate nutrition essential. Breast milk alone is insufficient to meet the nutritional needs of premature infants, so fortification is added to breast milk to support catch-up growth. Standard human milk fortification (HMF) is typically started when the feeding volume reaches 100 ml/kg/day, but research suggests that early HMF administration can increase protein intake sooner without negative effects on the infant. Early HMF administration didn't increase the incidence of food intolerance and necrotizing enterocolitis (NEC). Other studies have shown that early fortification increases the rate of early weight gain without increasing the incidence of complications. There is no research in Indonesia comparing the duration of regaining birth weight between early HMF and standard HMF. This study aims to determine the difference in the duration of regaining birth weight in very premature or VLBW infants given early HMF versus standard HMF. The research method is a prospective, randomized, double-blind preliminary study comparing early HMF administration (when feeding volume reached 30 ml/kg/day) with standard HMF (when feeding volume reached 100 ml/kg/day).
- Conditions
- Very Preterm Infant, Very Low Birth Weight Infants
- Being tested
- Early Fortification, Standard Fortification
- Keywords
- Early fortification, Return to birth weight, Very low birth weight, Very preterm infants
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Early FortificationDietary supplement
In the early fortification group, 1 sachet of HMF was added to 30 ml of breast milk for the first 24 hours. If the feeding tolerance was good, 1 sachet of HMF was then mixed into 25 ml of breast milk.
Standard FortificationDietary supplement
In the standard fortification group, 1 sachet of HMF was mixed into 25 ml of breast milk starting from the first day of HMF administration.
| Study group | Role | What they receive |
|---|---|---|
| Early Fortification Group | Experimental | Participants were given early fortification when the feeding volume reached 30 ml/kg/day Receives: Dietary Supplement: Early Fortification |
| Standard Fortification Group | Experimental | Participants were given standard fortification when the feeding volume reached 100 ml/kg/day Receives: Dietary Supplement: Standard Fortification |
What is being measured
The primary outcome is the main question the study is designed to answer.
Return to birth weight
The first day the infants reached their birth weight again
Measured: Body weight will be measured daily from birth until the day the infant first reaches their birth weight. The assessment period is expected to last up to 3 weeks after birth.
Secondary outcomes (3)
Number of Participants with Feeding Intolerance
Feeding intolerance was defined as inability to tolerate enteral feeding, characterized by a gastric residual volume greater than 50% (with or without regurgitation), vomiting, abdominal distension, decreased frequency of bowel movements, and disruption of the feeding plan.
Measured: Feeding intolerance will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
Number of Participants with Electrolyte Imbalances
Electrolyte imbalance was identified when serum levels fell below institutional laboratory reference ranges, with assessments performed for all study subjects.
Measured: Electrolytes will be assessed once during intervention. Blood sampling will be scheduled by the attending physician. The intervention period starts with HMF administration and ends when birth weight is regained, expected within 3 weeks after birth.
Number of Participants with Necrotizing Enterocolitis
Necrotizing enterocolitis was defined as a disorder of the intestinal mucosa, clinically manifested by feeding intolerance, bloody stools, and possibly accompanied by changes in abdominal skin color, supported by abdominal X-ray findings consistent with necrotizing enterocolitis.
Measured: Necrotizing enterocolitis will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Oct 2026
- Study start10 Nov 2024
- Primary completion30 Jun 2025
- Study completion30 Jun 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for Very Preterm InfantStudies of the same condition, open and under way.
- More trials run by Universitas IndonesiaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants are assigned to two groups either early fortification (when feeding volume reaches 30 ml/kg/day) or standard fortification (when feeding volume reaches 100 ml/kg/day)
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 44 participants (actual)
Sponsor and investigators
- Lead sponsor
- Universitas Indonesia
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Putri Maharani Tristanita Marsubrin, MD, PhD, Universitas Indonesia
- Investigators
- Putri MT Marsubrin, MD, PhD, Principal investigator, FKUI RSCM
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07861984
- Sponsor's protocol ID
- 24-06-0986
- Status last verified
- Aug 2026
- First submitted
- 27 Aug 2026
- Last updated
- 6 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database Syst Rev. 2020 Jul 29;7(7):CD013392. doi: 10.1002/14651858.CD013392.pub2.
PubMed 32726863Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawoger R, Kiechl-Kohlendorfer U, Chan GM, Blanco CL, Abrams S, Cotten CM, Laroia N, Ehrenkranz RA, Dudell G, Cristofalo EA, Meier P, Lee ML, Rechtman DJ, Lucas A. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010 Apr;156(4):562-7.e1. doi: 10.1016/j.jpeds.2009.10.040. Epub 2009 Dec 29.
PubMed 20036378Joosten K, Vermeulen M. Principles of feeding the preterm infant. Clin Nutr ESPEN. 2024 Feb;59:320-327. doi: 10.1016/j.clnesp.2023.12.016. Epub 2023 Dec 20. No abstract available.
PubMed 38220393Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr. 2024 Jun;15(6):100220. doi: 10.1016/j.advnut.2024.100220. Epub 2024 Apr 24.
PubMed 38670164Alizadeh Taheri P, Sajjadian N, Asgharyan Fargi M, Shariat M. Is early breast milk fortification more effective in preterm infants?: a clinical trial. J Perinat Med. 2017 Nov 27;45(8):953-957. doi: 10.1515/jpm-2015-0375.
PubMed 27676603Gupta G, Murugesan A, Thanigainathan S, Adhisivam B. Does Early Fortification of Human Milk Decrease Time to Regain Birth Weight as Compared to Late Fortification Among Preterm Infants? - A Randomized Controlled Trial. Indian J Pediatr. 2025 Jun;92(6):592-597. doi: 10.1007/s12098-024-05066-5. Epub 2024 Feb 28.
PubMed 38416365Shah SD, Dereddy N, Jones TL, Dhanireddy R, Talati AJ. Early versus Delayed Human Milk Fortification in Very Low Birth Weight Infants-A Randomized Controlled Trial. J Pediatr. 2016 Jul;174:126-131.e1. doi: 10.1016/j.jpeds.2016.03.056. Epub 2016 Apr 23.
PubMed 27112041Marsubrin PMT, Rohsiswatmo R, Sjarif DR. Preterm human milk composition and dietary intake of breastfeeding mothers in the Indonesian population. Paediatr Indones. 2021;61:20-24.
Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011 Jul;41(6):158-76. doi: 10.1016/j.cppeds.2011.01.001.
PubMed 21684471Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open. 2020 Sep 15;4(1):e000740. doi: 10.1136/bmjpo-2020-000740. eCollection 2020.
PubMed 32984553Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gulmezoglu AM. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019 Jan;7(1):e37-e46. doi: 10.1016/S2214-109X(18)30451-0. Epub 2018 Oct 30.
PubMed 30389451Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, Okwaraji YB, Mahanani WR, Johansson EW, Lavin T, Fernandez DE, Dominguez GG, de Costa A, Cresswell JA, Krasevec J, Lawn JE, Blencowe H, Requejo J, Moran AC. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023 Oct 7;402(10409):1261-1271. doi: 10.1016/S0140-6736(23)00878-4.
PubMed 37805217
Study at a glance
From the registry record, last updated by the sponsor on 6 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Early Fortification to Shorten Birth Weight Recovery Time in Very Preterm or Very Low Birth Weight Infants
- ClinicalTrials.gov ID
- NCT07861984
- Acronym / sponsor ID
- 24-06-0986
- Conditions
- Very Preterm Infant, Very Low Birth Weight Infants
- Keywords
- Early fortification, Return to birth weight, Very low birth weight, Very preterm infants
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 44 participants (actual)
- Lead sponsor
- Universitas IndonesiaUniversity, hospital or other
- Study start
- 10 Nov 2024 (actual)
- Primary completion
- 30 Jun 2025 (actual)
- Study completion
- 30 Jun 2025 (actual)
- First posted
- 6 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Very premature or very low birth weight (VLBW) infants are at risk of suboptimal growth after birth, making adequate nutrition essential. Breast milk alone is insufficient to meet the nutritional needs of premature infants, so fortification is added to breast milk to support catch-up growth. Standard human milk fortification (HMF) is typically started when the feeding volume reaches 100 ml/kg/day, but research suggests that early HMF administration can increase protein intake sooner without negative effects on the infant. Early HMF administration didn't increase the incidence of food intolerance and necrotizing enterocolitis (NEC). Other studies have shown that early fortification increases the rate of early weight gain without increasing the incidence of complications. There is no research in Indonesia comparing the duration of regaining birth weight between early HMF and standard HMF. This study aims to determine the difference in the duration of regaining birth weight in very premature or VLBW infants given early HMF versus standard HMF. The research method is a prospective, randomized, double-blind preliminary study comparing early HMF administration (when feeding volume reached 30 ml/kg/day) with standard HMF (when feeding volume reached 100 ml/kg/day).
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
- Model description
- Participants are assigned to two groups either early fortification (when feeding volume reaches 30 ml/kg/day) or standard fortification (when feeding volume reaches 100 ml/kg/day)
| Arm | Type | Receives |
|---|---|---|
| Early Fortification Group | Experimental | Dietary Supplement: Early FortificationParticipants were given early fortification when the feeding volume reached 30 ml/kg/day |
| Standard Fortification Group | Experimental | Dietary Supplement: Standard FortificationParticipants were given standard fortification when the feeding volume reached 100 ml/kg/day |
Who may qualify
- Ages
- 28 to 32 weeks
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child
Key inclusion criteria (3 listed)
- Very preterm infants (gestational age 28 to <32 weeks) or very low birth weight infants (birth weight 1000 to <1500 grams)
- Infants receiving at least 50% of their daily enteral needs from breast milk
- Infants whose parents provided written informed consent to participate in the study
Key exclusion criteria (8 listed)
- Infants with major congenital abnormalities
- Infants with grade 2 or grade 3 NEC or spontaneous intestinal perforation (SIP) before the intervention
- Infants who had already achieved return to birth weight (RTBW) before initiation of the intervention
- Infants with insufficient breast milk availability to provide ≥50% of their daily enteral requirements before enrollment
- Infants born to mothers with medical conditions that precluded breastfeeding
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Early FortificationIn the early fortification group, 1 sachet of HMF was added to 30 ml of breast milk for the first 24 hours. If the feeding tolerance was good, 1 sachet of HMF was then mixed into 25 ml of breast milk. | Dietary supplement | Early Fortification Group |
| Standard FortificationIn the standard fortification group, 1 sachet of HMF was mixed into 25 ml of breast milk starting from the first day of HMF administration. | Dietary supplement | Standard Fortification Group |
Primary outcome
Return to birth weight
Time frame: Body weight will be measured daily from birth until the day the infant first reaches their birth weight. The assessment period is expected to last up to 3 weeks after birth.
The first day the infants reached their birth weight again
3 secondary outcomes
Number of Participants with Feeding Intolerance
Time frame: Feeding intolerance will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
Number of Participants with Electrolyte Imbalances
Time frame: Electrolytes will be assessed once during intervention. Blood sampling will be scheduled by the attending physician. The intervention period starts with HMF administration and ends when birth weight is regained, expected within 3 weeks after birth.
Number of Participants with Necrotizing Enterocolitis
Time frame: Necrotizing enterocolitis will be monitored from the initiation of HMF administration until the day the infant first reaches their birth weight. The monitoring period is expected to last up to 3 weeks after birth.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Oct 2026.
- Background: PubMed 32726863Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database Syst Rev. 2020 Jul 29;7(7):CD013392. doi: 10.1002/14651858.CD013392.pub2.
- Background: PubMed 20036378Sullivan S, Schanler RJ, Kim JH, Patel AL, Trawoger R, Kiechl-Kohlendorfer U, Chan GM, Blanco CL, Abrams S, Cotten CM, Laroia N, Ehrenkranz RA, Dudell G, Cristofalo EA, Meier P, Lee ML, Rechtman DJ, Lucas A. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010 Apr;156(4):562-7.e1. doi: 10.1016/j.jpeds.2009.10.040. Epub 2009 Dec 29.
- Background: PubMed 38220393Joosten K, Vermeulen M. Principles of feeding the preterm infant. Clin Nutr ESPEN. 2024 Feb;59:320-327. doi: 10.1016/j.clnesp.2023.12.016. Epub 2023 Dec 20. No abstract available.
- Background: PubMed 38670164Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr. 2024 Jun;15(6):100220. doi: 10.1016/j.advnut.2024.100220. Epub 2024 Apr 24.
- Background: PubMed 27676603Alizadeh Taheri P, Sajjadian N, Asgharyan Fargi M, Shariat M. Is early breast milk fortification more effective in preterm infants?: a clinical trial. J Perinat Med. 2017 Nov 27;45(8):953-957. doi: 10.1515/jpm-2015-0375.
- Background: PubMed 38416365Gupta G, Murugesan A, Thanigainathan S, Adhisivam B. Does Early Fortification of Human Milk Decrease Time to Regain Birth Weight as Compared to Late Fortification Among Preterm Infants? - A Randomized Controlled Trial. Indian J Pediatr. 2025 Jun;92(6):592-597. doi: 10.1007/s12098-024-05066-5. Epub 2024 Feb 28.
- Background: PubMed 27112041Shah SD, Dereddy N, Jones TL, Dhanireddy R, Talati AJ. Early versus Delayed Human Milk Fortification in Very Low Birth Weight Infants-A Randomized Controlled Trial. J Pediatr. 2016 Jul;174:126-131.e1. doi: 10.1016/j.jpeds.2016.03.056. Epub 2016 Apr 23.
- BackgroundMarsubrin PMT, Rohsiswatmo R, Sjarif DR. Preterm human milk composition and dietary intake of breastfeeding mothers in the Indonesian population. Paediatr Indones. 2021;61:20-24.
- Background: PubMed 21684471Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011 Jul;41(6):158-76. doi: 10.1016/j.cppeds.2011.01.001.
- Background: PubMed 32984553Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open. 2020 Sep 15;4(1):e000740. doi: 10.1136/bmjpo-2020-000740. eCollection 2020.
- Background: PubMed 30389451Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gulmezoglu AM. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019 Jan;7(1):e37-e46. doi: 10.1016/S2214-109X(18)30451-0. Epub 2018 Oct 30.
- Background: PubMed 37805217Ohuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, Okwaraji YB, Mahanani WR, Johansson EW, Lavin T, Fernandez DE, Dominguez GG, de Costa A, Cresswell JA, Krasevec J, Lawn JE, Blencowe H, Requejo J, Moran AC. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet. 2023 Oct 7;402(10409):1261-1271. doi: 10.1016/S0140-6736(23)00878-4.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Putri MT Marsubrin, MD, PhD principal investigator
FKUI RSCM
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Early Fortification and Standard Fortification in people with Very Preterm Infant and Very Low Birth Weight Infants, run by Universitas Indonesia at 1 site in Indonesia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Indonesia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Return to birth weight (time frame: Body weight will be measured daily from birth until the day the infant first reaches their birth weight. The assessment period is expected to last up to 3 weeks after birth.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07861984, which also lists 12 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Oct 2026.