Response to Verd et al. re: “Preterm Infants May Better Tolerate Feeds at Temperatures Closer to Freshly Expressed Breast Milk: A Randomized Controlled Trial”

Dear Editor:

We thank Verd et al. ¹ for comments on our study “Preterm Infants May Better Tolerate Feeds at Temperatures Closer to Freshly Expressed Breast Milk: A Randomized Controlled Trial.” ² They commented on the difference in the frequency of inotrope use in our randomly selected study groups and asked questions about the relationship between hypotension/inotrope use and the adverse clinical outcome with regard to the feeding milk temperature.

In our study, there was an increased inotrope use in Group 1 that is the group of infants fed with milk at room temperature (n = 7; 17.5%) versus Group 2 the infants fed with milk close to body temperature (n = 0; 0%) as they drew attention. However, five of these seven patients had been given low (renal) dose (3 μg/kg) of inotrope (dopamine) treatment only on the first 24–48 hours of life. All patients were normotensive and inotrope free at the initiation of enteral feeding. The remaining two patients needed inotrope treatment later due to late onset sepsis. No relationship between hypotension/inotrope need and apnea/feeding intolerance/necrotizing enterocolitis (NEC) was observed when these seven cases were separately analyzed and compared with the cases without previous or later inotrope use.

Therefore, it cannot be concluded that colder milk causes hypotension nor the increased inotrope use can cause increased apnea, feeding intolerance in the colder milk group.

Again the results of our study showed significantly better feeding tolerance and less apnea in infants fed with milk closer to body temperature, being more physiologic and similar to breastfeeding or the freshly expressed milk temperature compared with room temperature of 22–24°C. These results can be confirmed in larger series.