The effects of human milk fortification on nutrients and milk properties

Donovan, Ramona; Kelly, Siobhan; Prazad, Preetha; Talaty, Pooja; Lefaiver, Cheryl; Hastings, Michelle L.; Everly, David N.

doi:10.1038/jp.2016.166

Cited by 26 publications

(37 citation statements)

References 29 publications

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“…This finding contrasts with some earlier studies that reported increases in osmolality of fortified EHM after storage. 8,12,13 However, those studies used a variety of other fortifiers, for periods of storage ranging from 24 to 72 hours. Moreover, the reported changes in osmolality were consistently small (10 mOsm/kg, or 3%-4%).…”

Section: Discussionmentioning

confidence: 99%

Effects of Nutrition Supplementation on Osmolality of Expressed Human Milk

Lamport

Hartman

Codipilly

et al. 2018

J Parenter Enteral Nutr

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Background Provision of human milk to premature infants optimizes outcomes, but it must be supplemented to meet their nutrient and caloric requirements for growth. Our objective was to quantify the osmolality of human milk mixed with commercially available human milk fortifiers (HMF) and powdered infant formula, as currently fed to premature infants, simulating standard neonatal intensive care unit feeding practices for mixing and refrigerator storage. Methods Expressed human milk (EHM) samples obtained from mothers of premature infants (≤32 weeks gestation) were mixed with standard commercial products, and osmolalities were quantified. Results HMF significantly increased the micronutrient content and osmolality of EHM. Osmolalities were 291 ± 6 mOsm/kg (mean ± SD) for unsupplemented milk, and 505 ± 5 and 315 ± 19 mOsm/kg after supplementation to 24 kcal/oz using 2 current U.S. Liquid EHM fortifiers. When using powdered infant formulas to further increase the caloric content of fortified EHM >24 kcal/oz, osmolalities increased by 10.5–23.0 mOsm/kg for each additional kcal/oz. The use of powdered formulas alone (without HMF) increased osmolality without comparable increases in nutrient content. Refrigeration for 24 hours did not affect osmolalites. Conclusion Our finding that several common feeding formulations exceed 450 mOsm/kg, and the lack of evidence of adverse effect, raise the question of whether current maximum osmolality guidelines should be reevaluated to enable optimal nutrition for infants in neonatal intensive care.

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Section: Discussionmentioning

confidence: 99%

Effects of Nutrition Supplementation on Osmolality of Expressed Human Milk

Lamport

Hartman

Codipilly

et al. 2018

J Parenter Enteral Nutr

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“…One of the major differences in ELHMF, in comparison to SLHMF, is the level of acidification of ELHMF (pH: 4.82-5.1 vs. 6.21-6.53). 20 We observed a probable clinical translation of this difference resulting in a significant metabolic acidosis in the ELHMF group. Previous investigators have also reported observations along these same lines.…”

Section: Discussionmentioning

confidence: 63%

“…Recently, Donovan et al has also shown that the lipase activity in HM fortified with EHLMF is approximately 8% lower than SLHMF. 20 Our findings of relatively poor weight gain in the ELHMF group can be explained by the decreased bioavailability of both protein and lipids in these preterm babies. We relied, as previous researchers, on the manufacturer's data on calorie and protein intake in the breast milk and HMF.…”

Section: Discussionmentioning

confidence: 69%

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Prospective Comparison of Enfamil and Similac Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants

et al. 2017

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Objective To compare growth and metabolic outcomes of premature infants receiving either Enfamil liquid human milk fortifier (ELHMF) or Similac liquid human milk fortifier (SLHMF). Study Design Infants born at ≤31 weeks' gestational age (GA) with birth weights <1,500 g and exclusively fed on human milk (mother's milk and/or donor milk) were prospectively assigned alternatively to one of the two liquid human milk fortifier (LHMF) groups. Baseline demographic, growth, enteral nutrition, and laboratory data were compared after fortification. Results In total, 31 preterm infants were recruited (ELHMF = 16; SLHMF = 15) with a mean GA of 27.1 ± 2.1 weeks and birth weight of 993 ± 245 g. The SLHMF group had significantly better weight gain as measured by individual weight z-scores (p = 0.008), better median weight gain velocity (p = 0.014), and less metabolic acidosis (p = 0.016). Overall weight gain was significantly better on mother's own milk in both the fortifier groups. The SLHMF group showed a trend toward higher growth velocity on donor milk compared with ELHMF (p = 0.06). We also observed a higher reticulocyte count (p = 0.003) in the SLHMF group compared with the ELHMF group. Conclusion In premature infants, between the two liquid human milk fortifiers, ELHMF fortifier is associated with relatively less weight gain and more metabolic acidosis.

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“…A alta variação nutricional existente no leite de cada mãe também desafia a fortificação padrão já conhecida com as fórmulas à base de proteína heteróloga, que podem aumentar a ocorrência de intolerância alimentar e enterocolite necrotizante. (ROCHOW et al, 2015) (DONOVAN et al, 2017 Há uma crescente tendência na análise bed side do leite humano nas Unidades de Terapia Intensiva Neonatais, apesar de ser uma tecnologia de alto custo. São utilizados analisadores de leite humano por infravermelho que fornecem uma análise rápida do leite materno para conhecer o seu conteúdo de macronutrientes e adaptar essa fortificação que pode ser benéfica para o recém-nascido.…”

Section: Discussionunclassified

Perfil lipídico do concentrado com liofilizado de leite humano para alimentação de recém-nascidos pré-termo de muito baixo peso

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The effects of human milk fortification on nutrients and milk properties

Abstract: Nutrient composition of HM varies significantly by milk type. Although fortifiers enhance select nutrients, each has the potential to affect HM properties in a unique way and these affects may vary by milk type.

Cited by 26 publications

References 29 publications

Effects of Nutrition Supplementation on Osmolality of Expressed Human Milk

Effects of Nutrition Supplementation on Osmolality of Expressed Human Milk

Prospective Comparison of Enfamil and Similac Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants

Perfil lipídico do concentrado com liofilizado de leite humano para alimentação de recém-nascidos pré-termo de muito baixo peso

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