Prospective Comparison of Enfamil and Similac Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants

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To compare growth and metabolic outcomes of premature infants receiving either Enfamil liquid human milk fortifier (ELHMF) or Similac liquid human milk fortifier (SLHMF).

Study Design

Infants born at ≤31 weeks' gestational age (GA) with birth weights <1,500 g and exclusively fed on human milk (mother's milk and/or donor milk) were prospectively assigned alternatively to one of the two liquid human milk fortifier (LHMF) groups. Baseline demographic, growth, enteral nutrition, and laboratory data were compared after fortification.


In total, 31 preterm infants were recruited (ELHMF = 16; SLHMF = 15) with a mean GA of 27.1 ± 2.1 weeks and birth weight of 993 ± 245 g. The SLHMF group had significantly better weight gain as measured by individual weight z-scores (p = 0.008), better median weight gain velocity (p = 0.014), and less metabolic acidosis (p = 0.016). Overall weight gain was significantly better on mother's own milk in both the fortifier groups. The SLHMF group showed a trend toward higher growth velocity on donor milk compared with ELHMF (p = 0.06). We also observed a higher reticulocyte count (p = 0.003) in the SLHMF group compared with the ELHMF group.


In premature infants, between the two liquid human milk fortifiers, ELHMF fortifier is associated with relatively less weight gain and more metabolic acidosis.

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