NICUs that use fortified milk use CMDF. However, the evidence base supporting this practice is poor
The latest systematic review by Bown et al. analyzed 18 RCTs on the use of cow milk-derived multinutrient fortifiers.
The data indicates that fortification increased weight gain by 1.76 g/day, while gains in length and head circumference were negligible. Generally, the RCTs were small and methodologically poor. The incidence of NEC was higher in the fortified group, although the difference did not reach statistical significance.
While the clinical evidence of EHMD is quite extensive