Individualized fortification of breast milk in 41 Extremely Low Birth Weight (ELBW) preterm infants

Reali, Alessandra; Greco, Francesca; Marongiu, Guido; Deidda, Federica; Atzeni, Sandra; Campus, Roberta; Dessì, Angelica; Fanos, Vassilios

doi:10.1016/j.cca.2015.04.027

Cited by 12 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The aim of this study was the analysis of macronutrient composition of BM from mothers delivering preterm twins or triplets. We found a nutrient composition comparable to other authors' reports (although they investigated populations of premature singletons), which used similar spectroscopic methods (de Halleux & Rigo, 2013;McLeod et al, 2016;Reali et al, 2015). We report these results in Table 5.…”

Section: Discussionsupporting

confidence: 89%

“…The BM analysis shown in this article was included in an ongoing individualized fortification program undertaken at our Neonatal Intensive Care Unit (NICU; Reali et al, 2010Reali et al, , 2015, aimed at optimization of the samples intended for each neonate according to his or her particular needs. Therefore, it is not an experimental study but rather a welfare protocol, in which BM analysis is performed to improve its composition, which is often inadequate for preterm newborns.…”

Section: Study Populationmentioning

confidence: 99%

See 1 more Smart Citation

Breast Milk for Preterm Multiples: More Proteins, Less Lactose

Congiu

Reali

Deidda³

et al. 2019

Twin Res Hum Genet

Self Cite

View full text Add to dashboard Cite

Exclusive breastfeeding is currently recommended until at least 6 months of postnatal age, due to maternal breast milk (BM) unique composition and beneficial properties. In fact, BM modifies itself according to gestational age (GA) at birth, adapting its composition to neonatal requests during lactation. Multiple births represent about 3% of the whole pregnancies; such neonates result more vulnerable than full-term newborns, due to lower GA and birth weight (BW) and the higher incidence of perinatal complications. Although an adequate nutrition is fundamental for twins and other multiples, studies on this topic are lacking. We collected and analyzed BM from mothers of 19 twins and 5 triplets showing GA < 33 weeks and BW < 1500 g, comparing it to a control group of 28 preterm singletons. As a result, at GA ≤ 28 weeks, we observed that protein content is higher in BM for multiples (1.53 vs. 1.29 g per 100 ml), lactose concentration is greater in BM for singletons (6.72 vs. 6.34 g per 100 ml) and GA results the most relevant factor influencing BM protein composition. BM for multiples results higher in proteins and lower in lactose, if compared with singleton’s samples; this could promote and sustain growth and organ development in this vulnerable category. BM from multiples shows a trophic and immunologic role, since these neonates often show lower GA and BW instead of singletons. These findings could help in optimizing nutritional strategies and improving BM individualized fortification.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Study Populationmentioning

confidence: 99%

Breast Milk for Preterm Multiples: More Proteins, Less Lactose

Congiu

Reali

Deidda³

et al. 2019

Twin Res Hum Genet

Self Cite

View full text Add to dashboard Cite

show abstract

“…In recent years, data regarding the benefits of targeted fortification on preterm infant growth have been reported by other authors. Reali et al [ 26 ] showed that the use of targeted fortification led to improved growth rates in a cohort of extremely low birth weight infants (i.e., gestational age ≤30 weeks) in the absence of adverse events. The authors specifically reported a mean daily growth rate of 16.04 g/kg/day, which is higher than the mean weight increase observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Is targeted fortification of human breast milk an optimal nutrition strategy for preterm infants? An interventional study

et al. 2016

View full text Add to dashboard Cite

BackgroundFortifying human milk contributes to the prevention of postnatal growth failure in preterm infants. Because of the natural variability of human milk, targeted fortification of human milk has been advocated. However, data regarding the efficacy and safety of prolonged targeted fortification are scarce. We aimed to assess the safety of targeted fortification of human milk in preterm infants compared with standard fortification, as well as the effects on infant growth.MethodsWe conducted an interventional study during hospital stay in healthy very low birth weight preterm infants who were exclusively fed human milk. Pools of human milk collected for 24 h were analysed using mid-infrared transmission spectroscopy. Targeted fortification of human milk was performed by adding macronutrients to native human milk to obtain optimal ratios of fat (4.4 g), carbohydrates (8.8 g), and protein (3 g) per 100 ml. The intervention period lasted 4–7 weeks. Weekly weight and daily growth rates were compared with those of a standardized fortification group of very low birth weight preterm infants who received standard fortified human milk (n = 10). The osmolality as well as the metabolic and gastrointestinal tolerance were monitored. Intergroup differences were evaluated using the Mann–Whitney U-test.ResultsA total of 10 preterm infants (birth weight 1223 ± 195 g; gestational age 29.1 ± 1.03 weeks) were enrolled and 118 samples of pooled milk were analysed. On average, 1.4 ± 0.1 g of protein, 2.3 ± 0.5 g of carbohydrate, and 0.3 ± 0.1 g of fat per 100 ml were added to the milk. Osmolality values after target fortification were within recommended limits (376 ± 66 mOsml/kg). Weekly weight gain (205.5 g; 95 % CI 177–233 vs 155 g; 95 % CI 132–178; p = 0.025) and daily growth rates (15.7 g/kg/day; 95 % CI 14.5–16.9 vs 12.3 g/kg/day; 95 % CI 10.7–13.9; p = 0.005) were higher in infants receiving target fortification than in infants receiving standardized fortification. The infants receiving targeted fortified milk consumed similar volumes as infants in the standardized fortification group (148 ± 4.5 vs 146 ± 4 ml/kg/day). No signs of either gastrointestinal or metabolic intolerance were observed.ConclusionsTarget fortification appears to promote growth in very low birth weight preterm infants without any detrimental effects.Trial registration NCT02716337

show abstract

“…Despite these attempts to provide adequate nutrition, preterm infants tend to experience growth failure. Reali et al found that in their cohort of premature infants born with a weight appropriate for gestational age (AGA, 2.5–4.0 kg), as many as 71.4% weighed less than the 10th percentile at discharge from the hospital [ 45 ]. It is currently unclear whether the cause of growth failure is due to inadequate nutrient supply to the infant or due to non-nutritional mechanisms that can also restrict growth and energy stores, such as inflammation or illness [ 2 , 3 ].…”

Section: Premature Infants Are In An Energy-deficit Statementioning

confidence: 99%

The Energy Costs of Prematurity and the Neonatal Intensive Care Unit (NICU) Experience

2018

View full text Add to dashboard Cite

Premature neonates are in an energy deficient state due to (1) oxygen desaturation and hypoxia events, (2) painful and stressful stimuli, (3) illness, and (4) neurodevelopmental energy requirements. Failure to correct energy deficiency in premature infants may lead to adverse effects such as neurodevelopmental delay and negative long-term metabolic and cardiovascular outcomes. The effects of energy dysregulation and the challenges that clinicians in the Neonatal Intensive Care Unit (NICU) face in meeting the premature infant’s metabolic demands are discussed. Specifically, the focus is on the effects of pain and stress on energy homeostasis. Energy deficiency is a complex problem and requires a multi-faceted solution to promote optimum development of premature infants.

show abstract

Individualized fortification of breast milk in 41 Extremely Low Birth Weight (ELBW) preterm infants

Cited by 12 publications

References 26 publications

Breast Milk for Preterm Multiples: More Proteins, Less Lactose

Breast Milk for Preterm Multiples: More Proteins, Less Lactose

Is targeted fortification of human breast milk an optimal nutrition strategy for preterm infants? An interventional study

The Energy Costs of Prematurity and the Neonatal Intensive Care Unit (NICU) Experience

Contact Info

Product

Resources

About