Human milk is the preferred feed for preterm infants, yet it may need to be fortified for optimal growth and development. Standard fortification of human milk seldom meets the recommended intake of protein, leading to inadequate post-natal growth. This article aims to critically review different human milk fortification strategies with a focus on in-hospital growth of premature infants in resource-limited settings. Super, adjustable and target fortification are compared to standard fortification. Different growth outcome parameters limit comparability of findings, but super fortification and adjustable fortification present opportunities to explore. More uniform growth outcome assessment is recommended. Practical implementation and costeffectiveness in the local setting need to be investigated.
AimMacronutrient and energy content of human milk are largely assumed for fortification practices. The aim was to explore macronutrient and energy content of transition and mature human milk from South African mothers of preterm infants with a birth weight <1800 g. Secondary objectives compared day to night milk; and explored associations with selected innate factors.MethodsIn this single‐centre, observational study macronutrient and energy content of day, night and mixed samples of transition (first 14 days of life) and mature (from Day 15 of life) human milk were analysed with mid‐infrared spectroscopy.ResultsIn total, 116 samples (38 days; 37 night; 41 mixed) from 47 mothers were retained for statistical analysis. Mean true protein, carbohydrate, fat and energy content of mixed samples per 100 mL were 1.5 ± 0.4 g, 7.2 ± 0.7 g, 3.5 ± 0.9 g and 69.4 ± 9.9 kcal, respectively. Mixed transition milk (n = 9) had 1.9 ± 0.3 g protein and 67.4 ± 9.6 kcal and mixed mature milk (n = 32) 1.4 ± 0.4 g protein and 70.0 ± 10.1 kcal, per 100 mL.The protein content of transition (p = 0.004) and mature (p = 0.004) milk were significantly higher than published data. Transition milk: 1.5 g protein, 65 kcal; mature milk: 1.2 g protein, 72 kcal per 100 mL. Night samples had less fat (p = 0.014) and energy (p = 0.033) than day samples. With increasing day of life protein content declined (p = 0.003).ConclusionThe protein content of human milk from South African mothers of preterm babies differs from published data and has implications for human milk fortification practises.
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