Macronutrient variability in human milk from donors to a milk bank: Implications for feeding preterm infants

Abstract

Background and objectiveThe composition of human milk varies widely and impacts the ability to meet nutrient requirements for preterm infants. The purpose of this study is to use a large dataset of milk composition from donors to a milk bank to: (1) describe the macronutrient variability in human milk and how it contributes to the ability to meet the protein and calorie targets for the preterm infant using fortification with commercially available multi-nutrient fortifiers; (2) assess how temporal versus subject effects explain macronutrient variability; (3) determine how macronutrient variability contributes to the nutrient distribution in pooled donor milk.MethodsThis is a retrospective, observational study that analyzes the macronutrient data of 1,119 human milk samples from 443 individual donors to a milk bank. We test fortification strategies with potential basic, intermediate, and high protein and calorie commercial fortifiers. Additionally, we simulate the random pooling of multiple donors to model the impact of macronutrient variability on pooled donor milk.ResultsFat was the most variable nutrient and accounted for 80% of the difference in calories. A subject-effect predicted more of the variability after 4 weeks postpartum in all macronutrients (R2 > = 0.50) than a time-effect (R2 < = 0.28). When pooling multiple donors, variability was reduced by increasing the number of donors randomly selected for a pool or targeted pooling based on macronutrient analysis of donor pools. Over 75% of mature milk samples fortified with a basic protein fortifier did not meet daily protein targets of 3.5 g/kg without exceeding volumes of 160 ml/kg/day.ConclusionThere is a strong individual signature to human milk that impacts the pooling of donor milk, and the ability to meet protein and energy requirements for the preterm infant with basic and intermediate protein and calorie fortifiers.

Differences in Maternal Immunoglobulins within Mother’s Own Breast Milk and Donor Breast Milk and across Digestion in Preterm Infants

“…As a baseline validation, protein concentration was lower in DBM than in preterm milk, which validates the results of a previous study [23]. DBM is often donated from term-delivering mothers at late lactation time, whereas the MBM examined in this study was from preterm mothers at early lactation time, which may have higher antibody concentrations.…”

Macronutrient content of donor milk from a regional human milk bank: variation with donor mother–infant characteristics

“…Although derived from different statistical methods, the coefficients of determination for between-subject effects and lactation time effects are comparable with that described in the study by John et al (47) which analysed the macronutrient data of 1119 human milk samples from 443 individual donors to a milk bank (subject effects 67-79 % of the variance v. 51-82 % in the study by John et al). Despite the amount of inter-individual variability in HDM, it is perhaps reproducible between cohorts.…”

Macronutrient Analysis of Target-Pooled Donor Breast Milk and Corresponding Growth in Very Low Birth Weight Infants

“…NIR analysis revealed that the target-pooled DBM samples contained similar calories (18.7 vs. 18.0–18.7 kcal/oz) and protein concentrations (0.91 vs. 0.88–1.0 g/dL) compared to other recent analyses of multi-donor random-pooled DBM [18,19]. However, in these studies, samples were measured pre-pasteurization.…”