This prospective randomized controlled trial aims to study the neurodevelopmental outcomes of very low birth weight preterm infants receiving post-discharge human milk fortification versus those receiving standard unfortified feeds.

Preterm VLBW infants often experience growth faltering and extrauterine growth restriction despite improved NICU survival rates. While human milk fortification during NICU stay is standard practice, most centers discontinue fortification at discharge, potentially compromising post-discharge growth and development.

The 18-month study will be conducted at KEM Hospital’s Level 3 NICU, enrolling 200 inborn preterm infants weighing less than 1500 grams at 37 weeks gestation or less. Participants will be randomized into two groups namely intervention group receiving continued HMF supplementation until reaching 1800 grams weight, and control group receiving standard calcium, iron, and vitamin D supplementation post-discharge.

Primary Outcome is to compare neurodevelopmental outcomes at 12 months corrected age using Bayley Scales of Infant and Toddler Development 4th edition between both groups.

Secondary Outcomes are to Assess weight gain, length and head circumference growth until 40 weeks postmenstrual age, feed intolerance incidence, mortality, anemia of prematurity, retinopathy of prematurity, and osteopenia of prematurity.

Methodology will be that Infants will receive bovine-based HMF at 1 gram per 25ml of human milk. Follow-up includes twice-weekly visits until 1.5kg, then bi-weekly until 1.8kg, with neuromotor assessments at term, 3, 6, 9, and 12 months corrected age.

Sample size of 174 infants calculated with 80% power, accounting for 15% loss to follow-up, totaling 200 participants. Analysis will follow intention-to-treat principle using appropriate statistical tests.