Remarks

• The potential harm of mortality and necrotizing enterocolitis from fortification was considered by the GDG to be very uncertain due to the low quality of the included trials. The GDG also considered that the benefits of multicomponent fortifier were clinically important for the weight, length and head circumference of very preterm (< 32 weeks) or very-low-birth-weight (VLBW) (< 1.5 kg) infants. Thus, the GDG decided not to routinely recommend multicomponent fortifier for all preterm or LBW infants and suggested that fortification may be considered for very preterm or VLBW infants. This recommendation is conditional on shared decision-making with parents; this includes informing parents about the benefits and risks and the need for further research.
• The GDG noted that there were limited data on the type of fortifier used in the studies. Based on most trials included in the evidence review, the GDG suggests that commercially available multicomponent fortifiers specifically formulated for preterm infants may be considered.
• The GDG also noted that there were limited data on the timing of initiation and duration of fortification in the studies. The GDG suggests that the initiation and duration of multicomponent fortification should be based on clinical judgement.
• Mothers should also be encouraged and supported before and after birth to provide their own breastmilk (including colostrum) for their infants.