Evidence on the use of Cow Milk Derived Fortifiers

Despite ESPGHAN guidance, the use of fortifiers shows considerable differences in the UK.

Currently there is no national guidance on the use of fortifiers in the UK. A recent survey of neonatal dieticians identified considerable variability in practices across the country

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

Using CDMF fortifier may lead to CMPA/CMPI

It is estimated that cow milk contains approximately 30 proteins that are known to can sensitize human infants.
The linked article provides an excellent review of these:

The clinical manifestations, pathophysiology, and potential management of CMPI is summarised in the linked article below: