Safety of superfortification of human milk for preterm

Thatrimontrichai, Anucha; Janjindamai, Waricha

doi:10.5372/1905-7415.0506.107

Abstract

Background: The standard preparation of fortified preterm human milk (FHM), 1 to 2 packs of human milk fortifier (HMF) in 50 milliliters of expressed breast milk (EBM), may fail to meet the theoretical requirements of ill preterm infants. The superfortified preparation of preterm human milk (SHM), 3 packs in HMF in 50 milliliters of EBM, however, leads to concerns about the osmolality of the preparation, as the higher the osmolality, the greater the risk of necrotizing enterocolitis.

Objective: We evaluated the effect of the superfortification of HMF on the osmolality of EBM

Material and method: Twelve samples of EBM were collected from mothers of a gestational age of less than 37 weeks. We measured the osmolality of the preterm human milk (PHM), FHM, and SHM. The SHM was kept at room temperature to measure the osmolality at 10 minutes after fortification.

Results: The means (SD) osmolality of the PHM and FHM were 293.9 (12.7), 335.2 (18.7) mOsm/kg H2O, respectively. The means (SD) osmolality of SHM immediately after fortification and 10 minutes after fortification at room temperature are 370.6 (17.4) and 369.8 (17.2) mOsm/kg H2O respectively.

Conclusions: The measured osmolality of SHM was less than 450 mOsm/kg H2O. This is still within the international reference range for the composition of PHM, except Ca, P, Zn, Cu, vitamin A, B1, B2, niacin, and folic acid. Therefore, SHM should be considered for feeding in only high-risk preterm neonates for short-term periods. Adverse effects need to be observed.

References

1. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics. 2005; 115:496-506.10.1542/peds.2004-2491
Open DOI Search in Google Scholar Back to article
2. Morley R, Lucas A. Randomized diet in the neonatal period and growth performance until 7.5-8 y of age in preterm children. Am J Clin Nutr. 2000; 71:822-8.10.1093/ajcn/71.3.822
Search in Google Scholar Back to article
3. Quigley M, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev [serial on the Internet]. 2007 [cited 2010 Jul 3]; Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002971/frame.html.10.1002/14651858.CD002971.pub2
Search in Google Scholar Back to article
4. Anderson DM. Nutritional assessment and therapeutic interventions for the preterm infant. Clin Perinatol. 2002; 29:313-26.10.1016/S0095-5108(02)00008-8
Open DOI Search in Google Scholar Back to article
5. Schanler RJ, Oh W. Composition of breast milk obtained from mothers of premature infants as compared to breast milk obtained from donors. J Pediatr. 1980; 96: 679-81.10.1016/S0022-3476(80)80738-4
Open DOI Search in Google Scholar Back to article
6. Kashyap S, Schulze KF, Forsyth M, Dell RB, Ramakrishnan R, Heird WC. Growth, nutrient retention, and metabolic response of low-birth-weight infants fed supplemented and unsupplemented preterm human milk. Am J Clin Nutr. 1990; 52:254-62.10.1093/ajcn/52.2.254
Search in Google Scholar Back to article
7. Atkinson SA, Radde IC, Anderson GH. Macromineral balances in premature infants fed their own mothers’ milk or formula. J Pediatr. 1983; 102:99-106.10.1016/S0022-3476(83)80302-3
Open DOI Search in Google Scholar Back to article
8. Heiman H, Schanler RJ. Enteral nutrition for premature infants: the role of human milk. Semin Fetal Neonatal Med. 2007; 12:26-34.10.1016/j.siny.2006.10.00417185053
Search in Google Scholar Back to article
9. Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics. 1999; 103:1150-7.10.1542/peds.103.6.115010353922
Open DOI Search in Google Scholar Back to article
10. Kuschel Carl A, Harding Jane E. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews [serial on the Internet]. 2004; 1: Available from: http:// www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000343/frame.html.10.1002/14651858.CD000343.pub214973953
Search in Google Scholar Back to article
11. Kuschel Carl A, Harding Jane E. Protein supplementation of human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews [serial on the Internet]. 2000; 2: Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000433/frame.html.10.1002/14651858.CD00043310796362
Search in Google Scholar Back to article
12. Premji Shahirose S, Fenton T, Sauve Reg S. Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database of Systematic Reviews [serial on the Internet]. 2006; 1: Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003959/frame.html.10.1002/14651858.CD003959.pub216437468
Search in Google Scholar Back to article
13. Darlow Brian A, Austin N. Selenium supplementation to prevent short-term morbidity in preterm neonates. Cochrane Database of Systematic Reviews [serial on the Internet]. 2003; 4: Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003312/frame.html.10.1002/14651858.CD003312871335014583967
Search in Google Scholar Back to article
14. Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need. J Perinatol. 2009; 29:489-92.10.1038/jp.2009.5019444237
Open DOI Search in Google Scholar Back to article
15. Committee on Nutrition, American Academy of Pediatrics. Commentary on breast-feeding and infant formulas, including proposed standards for formulas. Pediatrics. 1976; 57:278-85.10.1542/peds.57.2.278
Search in Google Scholar Back to article
16. De Curtis M, Candusso M, Pieltain C, Rigo J. Effect of fortification on the osmolality of human milk. Arch Dis Child Fetal Neonatal Ed. 1999; 81:F141-3.10.1136/fn.81.2.F141172098110448185
Open DOI Search in Google Scholar Back to article
17. Janjindamai W, Chotsampancharoen T. Effect of fortification on the osmolality of human milk. J Med Assoc Thai. 2006; 89:1400-3.
Search in Google Scholar Back to article
18. Yong TE, Mangum B. Neofax 2010: A manual of drugs used in neonatal care. 23rd ed. Montvale: Thomson Reuters; 2010.
Search in Google Scholar Back to article
19. Thatrimontrichai A, Janjindamai W. Postprandial osmolality of gastric contents in very low-birth-weight infants fed expressed breast milk with additives. Southeast Asian J Trop Med Public Health. 2009; 40: 1080-6.
Search in Google Scholar Back to article
20. Hamosh M, Henderson TR, Ellis LA, Mao JI, Hamosh P. Digestive enzymes in human milk: stability at suboptimal storage temperatures. J Pediatr Gastroenterol Nutr. 1997; 24:38-43.10.1097/00005176-199701000-000109093984
Open DOI Search in Google Scholar Back to article
21. Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010; 50:85-91.10.1097/MPG.0b013e3181adaee019881390
Open DOI Search in Google Scholar Back to article
22. Klein CJ. Nutrient requirements for preterm infant formulas. J Nutr. 2002; 132:1395S-577S.10.1093/jn/132.6.1395S12042465
Search in Google Scholar Back to article
23. Piammongkol S, Marks GC, Williams G, Chongsuvivatwong V. Food and nutrient consumption patterns in third trimester Thai-Muslim pregnant women in rural southern Thailand. Asia Pac J Clin Nutr. 2004; 13:236-41.
Search in Google Scholar Back to article
24. Panpanich R, Vitsupakorn K, Harper G, Brabin B. Serum and breast-milk vitamin A in women during lactation in rural Chiang Mai, Thailand. Ann Trop Paediatr. 2002; 22:321-4.10.1179/02724930212500197612530281
Open DOI Search in Google Scholar Back to article
25. Ziegler EE, Fomon SJ. Potential renal solute load of infant formulas. J Nutr. 1989; 119:1785-8.10.1093/jn/119.suppl_12.1785
Search in Google Scholar Back to article
26. Campbell DE, Fleischman AR. Rickets of prematurity: controversies in causation and prevention. Clin Perinatol. 1988; 15:879-90.10.1016/S0095-5108(18)30680-8
Search in Google Scholar Back to article
27. Dieter HH, Schimmelpfennig W, Meyer E, Tabert M. Early childhood cirrhoses (ECC) in Germany between 1982 and 1994 with special consideration of copper etiology. Eur J Med Res. 1999; 4:233-42.
Search in Google Scholar Back to article
28. Hathcock JN, Hattan DG, Jenkins MY, McDonald JT, Sundaresan PR, Wilkening VL. Evaluation of vitamin A toxicity. Am J Clin Nutr. 1990; 52:183-202.10.1093/ajcn/52.2.1832197848
Search in Google Scholar Back to article
29. Strelling MK, Blackledge DG, Goodall HB. Diagnosis and management of folate deficiency in low birthweight infants. Arch Dis Child. 1979; 54:271-7. 10.1136/adc.54.4.2711545312453910
Open DOI Search in Google Scholar Back to article

Safety of superfortification of human milk for preterm

Abstract

Paradigm

My account