Protein Enrichment of Donor Breast Milk and Impact on Growth in Very Low Birth Weight Infants

Abstract

Protein content is often inadequate in donor breast milk (DBM), resulting in poor growth. The use of protein-enriched target-pooled DBM (DBM+) has not been examined. We compared three cohorts of very low birth weight (VLBW) infants, born ≤ 1500 g: DBM cohort receiving > 1-week target-pooled DBM (20 kcal/oz), MBM cohort receiving ≤ 1-week DBM, and DBM+ cohort receiving > 1-week DBM+. Infants followed a standardized feeding regimen with additional fortification per clinical discretion. Growth velocities and z-scores were calculated for the first 4 weeks (n = 69 for DBM, 71 for MBM, 70 for DBM+) and at 36 weeks post-menstrual age (n = 58, 64, 59, respectively). In total, 60.8% MBM infants received fortification >24 kcal/oz in the first 30 days vs. 78.3% DBM and 77.1% DBM+. Adjusting for SGA, length velocity was greater with DBM+ than DBM in week 1. Average weight velocity and z-score change were improved with MBM compared to DBM and DBM+, but length z-score decreased similarly across all groups. Incidences of NEC and feeding intolerance were unchanged between eras. Thus, baseline protein enrichment appears safe in stable VLBW infants. Weight gain is greatest with MBM. Linear growth comparable to MBM is achievable with DBM+, though the overall length trajectory remains suboptimal.

State of the evidence from clinical trials on human milk fortification for preterm infants*

“…There are also knowledge gaps regarding the macronutrient and micronutrient composition of human milk. [30][31][32] Standard fortification assumes a constant milk composition and infant requirements.…”

Growth after implementing a donor breast milk program in neonates <33 weeks gestational age or birthweight <1500 grams: Retrospective cohort study

“…Most commonly, DBM is from mothers of term infants at later stages of lactation [ 16 ]. Even though human milk banks may utilize target-pooling of milk to reduce nutritional variability and increase nutritional content to achieve a minimum caloric density of 20 kcal/oz, protein concentration is often inadequate [ 18 ] to support growth for preterm infants. According to the European Society for Pediatric Gastroenterology Hepatology and Nutrition, the recommended protein intake for extremely low birth weight (BW) preterm infants ranges from about 4.0 to 4.5 g/kg/day [ 19 ].…”

Investigating donor human milk composition globally to develop effective strategies for the nutritional care of preterm infants: Study protocol

“…Evidence regarding differences in preterm infant growth outcomes based on primary feeding type (MOM versus DHM) is limited to observational studies due to ethical issues of withholding MOM. Results of these observational studies are conflicting, with some studies reporting inferior growth with DHM feeding [9][10][11][12][13], and other studies showing no difference [14][15][16]. Inconclusive findings may be related to differences in fortification protocols and the underlying nutritional composition of human milk, which is not frequently measured or reported.…”