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Fortifying breast milk

Why does breast milk need fortification for preterm infants?

Breast milk fortifying

  • Breast milk is perfectly designed to meet all the nutritional needs of a term, newborn baby
  • Preterm infants, particularly those weighing less than 1.5 kg have special nutritional needs and unfortified breast milk may not be adequate source of nutrients for them.  For example, human milk provides insufficient amounts of protein, calcium, and other nutrients relative to the needs of preterm infants7
  • Although the milk of some mothers of preterm infants may be nutritionally complete, it remains so for only a brief period of time, thus breast milk alone may not support the intrauterine rates of growth and nutrient accretion that are the goals of feeding for preterm infants1,2,3
  • Given these nutritional considerations, and the physiological immaturity and anatomical deficiencies of low-birth weight infants, careful dietary management of this population is essential
  • Cochrane reviews have concluded that protein supplementation or multi-component fortification of human milk increases nitrogen retention, short term weight gain, linear and head growth and bone mineral content4,5
  • Two studies have highlighted the benefits of fortifying preterm breast milk on growth rate.  Preterm infants who were fed for at least 8-12 weeks with fortified breast milk have been shown to have significant improvements in calcium and phosphorus balance, serum calcium and phosphorus and bone mineral content compared to unfortified milk6,7
  • Therefore the use of fortified milk from the mother results in faster growth as well as having the other benefits of mother’s milk8 

References
  1. Weber A et al.  Breast milk from mothers of very low birth weight infants: variability in fat and protein content.  Acta Paediatr 2001; 90: 772-775.
  2. American Academy of Pediatrics.  Committee on Nutrition, Nutritional needs of low-birth weight infants.  Pediatrics 1983; 75(5): 976-986.
  3. Forbes G.  Human milk and the small baby.  Am J Dis Child 1982; 136: 577-578.
  4. Kuschel C, Harding J.  Protein supplementation of human milk for promoting growth in preterm infants (Cochrane review).  Cochrane Library, Oxford: Update Software; 2001; 2.
  5. Kuschel C, Harding J.  Multicomponent fortified human milk for promoting growth in preterm infants (Cochrane review).  Cochrane Library, Oxford: Update Software; 2001; 2.
  6. Kashyap S et al.  Growth, nutrient retention, and metabolic response of low-birthweight infants fed supplemented and unsupplemented preterm human milk.  Am J Clin Nutr 1990; 52: 254-262.
  7. Hayashi T et al.  Nutrient balance, metabolic response, and bone growth in VLBW infants fed fortified human milk.  Early Hum Dev 1994; 39: 27-36.
  8. Nutrition Committee, Canadian Paediatric Society.  Nutrient needs and feeding of premature infants.  CMAJ 1995; 152(11): 1765-1785.
  1. Weber A et al.  Breast milk from mothers of very low birth weight infants: variability in fat and protein content.  Acta Paediatr 2001; 90: 772-775.
  2. American Academy of Pediatrics.  Committee on Nutrition, Nutritional needs of low-birth weight infants.  Pediatrics 1983; 75(5): 976-986.
  3. Forbes G.  Human milk and the small baby.  Am J Dis Child 1982; 136: 577-578.
  4. Kuschel C, Harding J.  Protein supplementation of human milk for promoting growth in preterm infants (Cochrane review).  Cochrane Library, Oxford: Update Software; 2001; 2.
  5. Kuschel C, Harding J.  Multicomponent fortified human milk for promoting growth in preterm infants (Cochrane review).  Cochrane Library, Oxford: Update Software; 2001; 2.
  6. Kashyap S et al.  Growth, nutrient retention, and metabolic response of low-birthweight infants fed supplemented and unsupplemented preterm human milk.  Am J Clin Nutr 1990; 52: 254-262.
  7. Hayashi T et al.  Nutrient balance, metabolic response, and bone growth in VLBW infants fed fortified human milk.  Early Hum Dev 1994; 39: 27-36.
  8. Nutrition Committee, Canadian Paediatric Society.  Nutrient needs and feeding of premature infants.  CMAJ 1995; 152(11): 1765-1785.

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