Design: Double-blind randomised clinical trial, single level III NICU
Population: 130 infants born at 24–30 weeks' gestation
Primary outcome: Growth z-scores, fat-free mass and brain MRI metrics
Effect: No differences between targeted and standard fortification

A double-blind randomised trial in JAMA Pediatrics (14 September) enrolled 130 infants born at 24 to 30 weeks in one US neonatal unit. Both groups received standard fortification of maternal or donor milk. The intervention group had extra protein or fat added when point-of-care mid-infrared analysis of the milk showed it fell below targets.

There was no difference in weight, length or head circumference z-scores, fat-free mass or brain MRI measures at term. Unexpectedly, protein intake was slightly higher in the control group, and both groups met or exceeded recommended intakes.

Where standard fortification already delivers enough, individual milk analysis adds cost and work without measurable benefit. That is useful for units, including in India, weighing whether to buy an analyser.

Keep to a consistent standard fortification protocol
Add protein or energy for clinical growth faltering, as both arms did
Track weight, length and head circumference weekly on a preterm chart
Do not invest in point-of-care milk analysers on current evidence

Why it matters

It saves units from buying technology that did not change growth or brain development.

The statistics, in plain English

No outcome differed between groups. With 65 infants per arm, the trial could miss small effects, and because both groups met nutritional targets there was little room for the intervention to help.