The women enrolled in this study had low dietary DHA intake. Supplementation with preformed DHA at 1 g/day resulted in increased DHA concentrations in the donor milk with no adverse outcomes. Infants fed donor milk from supplemented women receive dietary DHA levels that closely mimic normal intrauterine accretion during the third trimester.
Background. Mother’s own milk is the first choice for feeding preterm infants, but when not available, pasteurized human donor milk (PDM) is often used. Infants fed PDM have difficulties maintaining appropriate growth velocities. To assess the most basic elements of nutrition, we tested the hypotheses that fatty acid and amino acid composition of PDM is highly variable and standard pooling practices attenuate variability; however, total nutrients may be limiting without supplementation due to late lactational stage of the milk. Methods. A prospective cross-sectional sampling of milk was obtained from five donor milk banks located in Ohio, Michigan, Colorado, Texas-Ft Worth, and California. Milk samples were collected after Institutional Review Board (#07-0035) approval and informed consent. Fatty acid and amino acid contents were measured in milk from individual donors and donor pools (pooled per Human Milk Banking Association of North America guidelines). Statistical comparisons were performed using Kruskal–Wallis, Spearman’s, or Multivariate Regression analyses with center as the fixed factor and lactational stage as co-variate. Results. Ten of the fourteen fatty acids and seventeen of the nineteen amino acids analyzed differed across Banks in the individual milk samples. Pooling minimized these differences in amino acid and fatty acid contents. Concentrations of lysine and docosahexaenoic acid (DHA) were not different across Banks, but concentrations were low compared to recommended levels. Conclusions. Individual donor milk fatty acid and amino acid contents are highly variable. Standardized pooling practice reduces this variability. Lysine and DHA concentrations were consistently low across geographic regions in North America due to lactational stage of the milk, and thus not adequately addressed by pooling. Targeted supplementation is needed to optimize PDM, especially for the preterm or volume restricted infant.
Human milk is the preferred choice for infant feeding. When a sick or premature infant's own mother's milk is unavailable, donor human milk is becoming more widely used. Many potential milk donors do not live within close proximity to the 10 North American not-for-profit milk banks. Transporting milk via commercial carriers can be inconvenient and costly for recipient banks. A network of donor human milk depots is one practical way to increase the quantity of available donor human milk. This article provides guidelines and practical suggestions for establishing a donor human milk depot.
BackgroundDHA is an important fatty acid for neurodevelopment and immune homeostasis in the neonate. In our first study we found low levels of DHA in donor milk (0.1mol wt%). As a result our preterm infants receive 13 mg/day of DHA fed 150ml/kg/day as compared to fetal accretion of 65 mg/day. Dietary intake correlates well with milk concentrations but a paucity of data exists as to the amount in a donor milk population.ObjectiveWe tested the hypotheses that dietary DHA would be significantly lower than 200 mg per day suggested intake for lactation.MethodsAfter IRB approval and informed consent, human milk donors to the Mother's Milk Bank of Ohio completed dietary records. Dietary Analysis was done using NDST software by a trained individual. Statistics were done using Wicoxon Signed Rank Test.ResultsN= 14 had complete records. Donor age was 27–39 years with lactational stage 2–11 months. Origin of donors were OH, PA, MA, and NY. Dietary analysis demonstrated low intake of DHA with a median value of 23 mg per day (0–194mg range) in all participants which was significantly different from 200 mg/day (p = 0.0001).Neither age nor lactational stage correlated with DHA intake.ConclusionsThe donor milk population demonstrated low dietary intake of DHA. Next, the other 9 North America milk banks should be evaluated to determine if this is a regional experience or if supplementation with DHA >200mg/day is required for mothers providing human milk.Funding: Intramural support from the Research Institute
BackgroundPreterm infants are often fed donor milk (DM) when mother's milk is not available; however, there is a paucity of data on the free amino acid (FAA) profile of DM.ObjectivesOur hypotheses were that free amino acids would be effected by pasteurization and would have FAA levels different than in milk provided by preterm mothers.Methods38 donor milk samples were collected after informed consent and IRB approval (#0600532). Lactational stages 1‐10 months were combined into 16 pools to minimize variability. Free amino acids were measured pre and post PST by HPLC. Analysis was done using two sample t‐tests with unequal variances.ResultsOnly two free amino acids were significantly different (p<0.0027) after PST of which Arginine was higher and Aspartate was lower. When comparing our PST samples to previous published amino acid means, our PST samples had significantly lower Glycine , Aspartate , Valine, Phenylalanine, Proline, Lysine, Arginine, Serine, whereas Histidine and Tyrosine were higher.ConclusionThe finding that PST alters FAA concentrations minimally is reassuring but differences from previous fresh milk concentrations prompt further investigation into targeted lactational stage or amino acid supplementation for the donor milk fed immature neonate.
BackgroundDHA and AA are important nutrients for the growing infant and have been previously shown to be limiting in a Midwestern donor bank. With the increased use of donor milk nationally, it is imperative to understand if these low values are consistent across the United States (U.S.).ObjectivesWe tested the hypotheses that the DHA and AA would be lower nationally in donor milk for the high risk infant.MethodsA prospective sampling of milk from 6 milk banks in North America‐ (New England [NE], Ohio, Michigan, Colorado, Ft Worth, Texas, and California) were collected after informed consent and IRB approval. 15‐ 16 milk samples with lactational stage 1–5.5 months were obtained from each milk bank (except NE, n=6). The samples were pooled to minimize variability. DHA was measured by GC; AA were measured by HPLC. Kruskal‐ Wallis with Dunn's Multiple Comparison was used in analysis.ResultsThe DHA content did not differ significantly across banks (median value of 29–39 mg/100 ml), but overall, provided an intake lower than the fetal accretion value for the high risk neonate. AA did not differ except for isoleucine and leucine which were significantly higher in NE (p=0.03)ConclusionNationally, donor milk is low in DHA and variable for isoleucine and leucine. Since the primary target for donor human milk is the high risk neonate, this survey should prompt nutrient supplementation strategies.
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