Development of macronutrient composition of very preterm human milk

Abstract

The effects of gestational age at delivery (GA), postnatal age (PNA) and post-menstrual age (PMA = PNA + GA, an indicator of autonomous developmental processes not affected by the moment of birth) on macronutrient composition of very preterm milk were studied. Total N, fat, lactose and carbohydrate concentrations, energy density and 24 h volume were determined in 282 24 h milk samples collected at weekly intervals (days 7-55 of lactation) from seventy-nine women delivering their babies between 25 and 29 weeks of gestation. GA related differences were found for carbohydrate concentration only: carbohydrate concentration was lower with increasing GA. PNA was related to a decrease in total N and an increase in lactose concentration. PMA was not related to milk composition. Our data indicate that PNA strongly influences the development of the composition of very preterm human milk, while GA affects carbohydrate content with a negligible effect on the nutritional value of the milk. We conclude that in accordance with current opinion in paediatrics, human milk is the best source of nutrients even for very preterm (Ͻ 30 weeks GA) infants.

Preterm human milk composition: a systematic literature review

“…This is despite the reformulation of several human milk fortifiers since the latest enteral guidelines were released in 2010 (8) , suggesting that current nutrition regimens, including fortification practices, may still not be sufficiently optimised to meet the needs of extremely preterm infants. (33) Average 28·3 -Days 6-8, 13-15 N, lipid, lactose, E* Bauer & Gerss (6) 23-33 102 1-8 weeks Pro, lipid, carbohydrate, E Beijers et al (34) 25·7-36 45 1, 2 and 4 weeks N Beijers & Schaafsma (35) <36 65 Days 0-5, 6-14, 15-55 Lipid Chessex et al (36) Average 30·3 1 1 -N, lipid, carbohydrate, E* Corvaglia et al (13) 26-32 55 Day 10 N, lipid Ehrenkranz et al (37) 26-33 21 Days 2, 7, 14, 28, 42 Lipid Faerk et al (38) <32 (average 28) 101 1-10 weeks N, lipid, carbohydrate, E* Gross et al (20) 27-32 (43) 26-36 58 Days 1-28 N Maas et al (44) 25-29 79 1-11 weeks N, lipid, lactose, carbohydrate, E* Saarela et al (45) Average 31·4 36 1 week, 1, 2, 3, 4, 5, 6 months N, lipid, lactose, E* Sann et al (46) 26-35 41 < 6, 7-14, >15 d Pro, lipid, lactose Silber et al (47) Average 29·6 5 Days 9-17 N, lipid, lactose, E Stevens (48) 34-36 weeks 7 Days 3-25 N E, energy; *, calculated; Pro, protein. (34) †, Ehrenkranz (37) , Faerk (38) , Gross (20) *, Guerrini (39) , Jitta (40) , Lemons (16) †, Lucas (43) *, Saarela (45) , Sann (46) , Stevens (48) Kjeldahl (16,34) Kjeldahl without NPN correction (18,20,33,45,48) Micro Kjeldahl (17) Semi-micro Kjeldahl (21) Semi-micro Kjeldahl without NPN correction …”

“…Atwater specific factor system (20) Atwater general factor system (45) Heats of combustion factors (18,33,38,40) Bomb calorimetry (6,16,17) 267·8 205·0-309·6 64·0 49·0-74·0 (34) †, Corvaglia (13) , Ehrenkranz (37) , Gross (20) *, Guerrini (39) , Jitta (40) , Lemons (16) †, Lepage (42) †, Lucas (43) *, Maas (44) †, Sann (46) , Stevens (48) , Silber (47) † Kjeldahl (16,34,42) Kjeldahl with NPN not accounted for (13,18,20,33,44,47,48) Micro Kjeldahl (17) Semi-micro Kjeldahl (21) Semi-micro Kjeldahl without NPN (32,43) Biuret (46) Lowry-Peterson (6) IR spectrophotometry (13) Esbach/Bogg (40) 1·67…”

“…1·46-2·40 Folch (37,46) Roese-Gottlieb (20,44) Colorimetry (16,18,33) Gerber (13) De la Huerga (39) Jeejeebhoy (47) Van de Kamer (17) Creamatocrit (40) IR spectrophotometry (13) 3·63 3·49-4·30 Lactose: Chromatography (16,46) Boehringer lactose assay kit (18,44) Unidentified (40) Unidentified (47) Unidentified (20) Total carbohydrate: Carbohydrate by difference (44) Beckman Glucose Analyzer (17) 5·94 7·11…”

“…Atwater specific factor system (20) Heats of combustion factors (18,33,40,44) Bomb calorimetry (16,17,42,47) 295·8 258·6-325.5 70·7 61·8-77·8 (34) †, Ehrenkranz (37) , Gross (20) *, Jitta (40) , Lemons (16) †, Lucas (43) *, Maas (44) †, Saarela (45) , Stevens (48) Kjeldahl (16,34) Kjeldahl without NPN correction (18,20,44,45,48) Semi-micro Kjeldahl (21) Semi-micro Kjeldahl without NPN correction (32,43) Lowry-Peterson (6) Esbach/Bogg (40) 1·37 0·88-2·10 Folch (37) Roese-Gottlieb (20,44,45) Colorimetry (16,18) Creamatocrit (6,40) 3·84 3·24-4·80 Lactose: Chromatography (16) Boehringer lactose assay kit (18,44) Unidentified (40) Unidentified (45) Unidentified (20) Total carbohydrate: Carbohydrate by difference (44) Colorimetry (6) 6·07 7·42…”

“…Atwater specific factor system (20) Atwater general factor system (45) Heats of combustion factors (18,40,44) Bomb calorimetry (6,16) 297·9 252·3-323·8 71·2 60·3-77·4 4 Bauer (6) *, Faerk (38) , Guerrini (39) , Lemons (41) †, Maas (44) † Kjeldahl (41) Kjeldahl without NPN correction (44) Lowry-Peterson (6) IR spectrophotometry (38) 1·33…”