Effect of fortification on the osmolality of human milk

Abstract

Aim-To evaluate the eVect of fortification on the osmolality of human milk. Methods-The osmolality of 47 samples of human milk was determined at baseline, just after, and 24 hours after supplementation with five diVerent human milk fortifiers (HMF) at 4°C. Results-Ten minutes after HMF supplementation the osmolality of human milk was significantly higher than the sum of the respective values of HMF dissolved in water and human milk, measured separately at baseline (p<0.0001), with the exception of the HMF containing only proteins. After 24 hours a further increase in osmolality was observed. Linear regression analysis showed that total dextrin content (r=0.84) was the main determinant of the increase. Conclusions-Human milk and HMF interact to induce a rapid increase in osmolality higher than would be expected from composition alone. This rise could be explained by the amylase activity of human milk, inducing hydrolysis of the dextrin content of HMF, leading to small osmotically active molecules of oligosaccharides. The high osmolality of fortified human milk should be considered in the nutritional management of preterm infants. (Arch Dis Child Fetal Neonatal Ed 1999;81:F141-F143)

Evaluation of human milk fortification from the time of the first feeding: effects on infants of less than 31 weeks gestational age

“…Literature shows that the fortification of human milk increases the osmolality of the milk 28 and also may decrease gastric motility as evidenced by increased residuals. 29 Fortification also slows gastric emptying, but in a preliminary study this has not been shown to be significant.…”

Effects of Human Milk Fortification on Morbidity Factors in Very Low Birth Weight Infants

“…In spite of the marginally higher content of sodium in the milk of babies receiving human milk fortifier, there was no significant difference in the frequency of feed intolerance and NEC in the two groups. This may also be related to the fact that human milk-fed babies have a very low incidence of NEC, as compared to babies on artificial feeds, 14 and fortified human milk, though marginally hyperosmolar than human milk alone, 15 does not predispose to the development of NEC and may be better than hypertonic saline added to the feeds in situations of hyponatremia during recovery periods of these LBW infants.…”

Breastfeeding in premature infants: in-hospital clinical management

“…Vale ressaltar, no entanto, que a manipulação do leite materno não é isenta de riscos. A adição de substâncias exógenas pode alterar a osmolaridade e afetar as propriedades intrínsecas de defesa do LH 8,92,95 . Além disso, nos países em desenvolvimento, nem sempre os aditivos estão disponíveis para todos os RNPT, e há a necessidade de se identificar quais deles seriam realmente beneficiados com essa suplementação nutricional 96 .…”