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Preterm human milk macronutrient concentration is independent of gestational age at birth
  1. Jan Maly1,
  2. Iva Burianova2,3,
  3. Veronika Vitkova2,
  4. Eva Ticha1,
  5. Martina Navratilova1,
  6. Eva Cermakova4
  7. On behalf of PREMATURE MILK study group
    1. 1Department of Paediatrics, Division of Neonatology, Faculty of Medicine, Charles University, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
    2. 2Department of Neonatology, Thomayer Hospital, Prague, Czech Republic
    3. 3Department of Paediatrics, Second Faculty of Medicine, Charles University, Prague, Czech Republic
    4. 4Faculty of Medicine, Computer Technology Centre, Charles University, Hradec Kralove, Czech Republic
    1. Correspondence to Dr Jan Maly, Department of Paediatrics, Division of Neonatology, Faculty of Medicine Charles University, University Hospital in Hradec Kralove, Hradec Kralove 500 05, Czech Republic; malyj{at}lfhk.cuni.cz

    Abstract

    Objective To evaluate the amount of macronutrients in aggregate of human milk samples after preterm delivery during the first 2 months of lactation.

    Methods Analysis of the donated single milk samples, gained by complete emptying of the whole breast at the same daytime between 24+0 and 35+6 gestational age (GA), was designed as prospective observational cohort trial. Two milk samples were analysed every postnatal week up to the discharge from the hospital, week 9 or loss of lactation. 24-Hour milk collection was not done. Analysis was performed using the MIRIS Human Milk Analyser (MIRIS AB, Uppsala, Sweden).

    Results A set of 1917 human milk samples donated by 225 mothers after preterm labour was analysed. Group A (24–30 GA) contains 969 milk samples; group B (31–35 GA) contains 948 milk samples. No difference in milk composition between the groups was identified. Median of true protein content decreased from 1.6 g/dL in group A and 1.5 g/dL in group B in the first week of life, to 1.1 g/dL in both groups at the end of week 3, and then remained stable up to week 9. Content of carbohydrates and fat was stable during the whole observation, with interindividual differences.

    Conclusion Human milk does not differ as a function of degree of prematurity. Protein content of preterm human milk is low and decreases during the first 3 weeks of lactation. Recommended daily protein intake cannot be achieved with routine fortification in majority of milk samples.

    • human milk
    • preterm birth
    • macronutrients

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    Footnotes

    • Contributors JM was primarily responsible for the study design, samples analysis, data analysis and interpretation, and drafted the final manuscript. IB was the coauthor of the study design; she was responsible for sample analysis, data analysis and interpretation, and manuscript preparation. VV, ET and MN were responsible for collecting the samples and analysis. EČ was responsible for statistical analysis.

    • Funding This work was supported by Nutricia a.s., Czech Republic, and PRVOUK programme P 37/12.

    • Competing interests None declared.

    • Ethics approval The study was approved by the Ethics Committee/Institutional Review Board of Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic (reference number 2 01 312 S21 P).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators K Borakova (Institute for Care of the Mother and Child, Prague, Czech Republic), T Brozova (Institute for Care of the Mother and Child, Prague, Czech Republic), L Kantor (Division of Neonatology, Palacky University, Faculty of Medicine and University Hospital, Olomouc, Czech Republic), J Kudlackova (Department of Neonatology, Thomayer Hospital, Prague, Czech Republic), T Matejek (Department of Paediatrics, Division of Neonatology, Charles University, Faculty of Medicine and University Hospital in Hradec Kralove, Czech Republic), M Panek (Division of Neonatology, Krajska zdravotni a.s., Usti nad Labem, Czech Republic), J Pankova (Division of Neonatology, Krajska zdravotni a.s., Usti nad Labem, Czech Republic), E Vokurkova (Department of Obstetrics and Gynaecology, Division of Neonatology, Charles University, First Faculty of Medicine, General University Hospital, Prague, Czech Republic), I Vranova (Division of Neonatology, Palacky University, Faculty of Medicine and University Hospital, Olomouc, Czech Republic) and B Zlatohlavkova (Department of Obstetrics and Gynaecology, Division of Neonatology, Charles University, First Faculty of Medicine, General University Hospital, Prague, Czech Republic).

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