Elsevier

The Journal of Pediatrics

Volume 163, Issue 4, October 2013, Pages 1001-1007
The Journal of Pediatrics

Original Article
Target Fortification of Breast Milk with Fat, Protein, and Carbohydrates for Preterm Infants

https://doi.org/10.1016/j.jpeds.2013.04.052Get rights and content

Objectives

Fortification of breast milk is an accepted practice for feeding very low birth weight infants, however, fixed dosage enhancement does not address variations in native breast milk. This could lead to deficiencies in calories and macronutrients. We therefore established the infrastructure for target fortification in breast milk by measuring and adjusting fat, protein, and carbohydrate content daily. We analyzed nutrient intake, growth, and safety variables.

Study design

Each 12-hour batch of breast milk was analyzed using near-infrared spectroscopy. Macronutrients were individually added to routine fortification to achieve final contents for fat (4.4 g), protein (3 g), and carbohydrates (8.8 g) (per 100 mL). Fully breast milk fed healthy very low birth weight infants (<32 weeks) were fed the fortified breast milk for at least 3 weeks. Matched pair analysis of 20 infants fed routinely fortified breast milk was performed using birth weight, gestational age, and postnatal age.

Results

All 650 pooled breast milk samples required at least 1 macronutrient adjusted. On average, 0.3 ± 0.4 g of fat, 0.7 ± 0.2 g of protein, and 1.2 ± 0.2 g of carbohydrate were added. Biochemistry was normal in the 10 target fortified infants (birth weight: 860 ± 309 g, 26.3 ± 1.6 weeks gestational age); weight gain was 19.9 ± 2.7 g/kg/d; and milk intake was 147 ± 5 mL/kg/d (131 ± 16 kcal/kg/d). Osmolality of fortified breast milk was 436 ± 13 mOsmol/kg. Matched pair analysis of infants indicated a higher milk intake (155 ± 5 mL/kg/d) but similar weight gain (19.7 ± 3.3 g/kg/d). No adverse event was observed. The linear relationship between milk intake and weight gain observed in study babies but not seen in matched controls may be related to the variable composition of breast milk.

Conclusions

Daily target fortification can be safely implemented in clinical routine and may improve growth.

Section snippets

Methods

The study was a prospective, single-center clinical trial to test feasibility and safety of target fortification of breast milk. The trial was conducted in the NICU (level 3) at the McMaster Children's Hospital in Hamilton, Ontario, Canada. Clinical data of infants enrolled in the trial were compared with data from infants who had been fed with routinely fortified breast milk using a matched pair analysis. The study was approved by the Research Ethics Board of McMaster University. Informed

Results

During the study period (March 2011- November 2011), informed consent was obtained for 23 infants. Thirteen infants were excluded from analysis; 5 infants were excluded prior to initiation of target fortification (3 infants were transferred to level 2 [L2] nursery, 1 developed sepsis, and 1 developed bloody stools). Eight infants did not complete 3 consecutive weeks (4 were transferred to L2 nurseries, mothers of 2 infants had insufficient breast milk supply, and 2 infants developed sepsis).

Discussion

In this study, we showed that target fortification of breast milk is a feasible clinical routine. We provided a defined enteral intake according to the ESPGHAN guidelines12; this was achieved by analyzing the composition of each 12-hour batch of pooled breast milk and adjusting macronutrients (fat, protein, and carbohydrate) accordingly. Infants on target fortification had growth rates, which were linearly correlated to the feeding volume. All safety measurements during the intervention were

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  • Cited by (0)

    C.F. holds the Hamilton Health Sciences Foundation–Jack Sinclair Chair in Neonatology at McMaster University, Faculty of Health Sciences. The authors declare no conflicts of interest.

    Registered with ClinicalTrials.gov: NCT01305642.

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