Elsevier

Early Human Development

Volume 82, Issue 12, December 2006, Pages 781-787
Early Human Development

Benefits of maternal and donor human milk for premature infants

https://doi.org/10.1016/j.earlhumdev.2006.09.009Get rights and content

Abstract

Nutrition support of the premature infant must be designed to compensate for metabolic and gastrointestinal immaturity, immunologic insufficiency, and the demands of associated medical conditions. The beneficial effects of human milk extend to the feeding of premature infants. While human milk enhances immunity, nutritional concerns arise because the milk may not meet the expanded nutrient requirements of the very low birth weight (VLBW, less than 1500 g) premature infant. Human milk fortifiers are available to provide optimum nutrition. This review summarizes the benefits and limitations of human milk for the premature infant.

Section snippets

Key guidelines

  • The nutrient components of human milk exhibit wide variability mandating nutrient supplementation, special handling, and monitoring of infant growth and nutritional status.

  • Mother's own milk with nutrient supplementation enhances the growth, development, and immunity of premature infants.

  • Extraordinary efforts should be made to use mother's own milk because the advantages of non-nutrient components in human milk are significantly diminished by storage and heat processing.

Research directions

  • Investigate donor milk processing by alternative techniques to preserve the non-nutritive advantages while preventing disease transmission.

  • Support strategies that enhance successful production and delivery of mother's own milk.

  • Evaluate long-term developmental benefits of feeding human milk in premature infants.

Variability in milk composition

The adequacy of nutrient intake is compromised by the variability in nutrient composition, both inherent to milk and imposed by circumstances of collection, storage in refrigerator and freezer, and distribution of the milk. A large variation in the energy and protein contents of human milk brought to the neonatal nursery by the mother is observed [1]. The most variable nutrient in human milk is fat, the content of which differs during lactation, throughout the day, from mother to mother, and

Donor milk composition: the effect of processing

Donor human milk is generally obtained from women who deliver term infants later in their lactation so the milk composition is similar to the lower nutrient content found in mature milk. Storage and processing of mother's own milk and donor milk alters some of the immunologic and nutritional properties [7]. Refrigerator storage at 4 °C for 24 h results in a loss of vitamin C (40%), lysozyme (40%), lactoferrin (30%), lipase activity (25%), sIgA (40%), and specific sIgA antibody (from 0 to 60%)

Growth of premature infants fed unfortified mother's own or donor human milk

When compared with supplemented human milk or formula, premature infants fed unfortified human milk have slower rates of growth and nutritional deficits, during and beyond their hospital stay [16], [17], [18], [19], [20]. When fed to premature infants (birth weight 1.0 to 1.4 kg) term, pooled, unpasteurized donor milk resulted in a rate of weight gain that was 50% of similar infants fed formula [21]. When fed term, pooled, pasteurized donor milk, premature infants (birth weight  1.6 kg) had a

Nutritional outcomes of premature infants fed unfortified mother's own or donor human milk

Indices of protein nutritional status, e.g., blood urea nitrogen, serum albumin, total protein, and transthyretin (prealbumin), are lower and continue to decline over time when premature infants are fed unfortified human milk [16], [19], [23]. As a consequence of the low intakes of calcium and phosphorus, infants fed unfortified human milk have progressive decreases in serum phosphorus, increases in serum calcium, and increases in serum alkaline phosphatase activity compared with infants fed

Effects of unfortified mother's own milk on infectious morbidity

Early prospective studies reported lower rates of infection in premature infants receiving fresh human milk compared with formula [30], [31]. A multi-center trial in the U.K. reported that necrotizing enterocolitis (NEC) was reduced significantly by feeding premature infants unfortified human milk, either exclusively or partially supplemented with either formula or pasteurized donor human milk compared with feeding a sole diet of formula [32]. That study identified the highest risk for NEC in

Effects of unfortified donor human milk on infectious morbidity

Donor milk is an alternative when obtained from established human milk banks that follow specific quality control protocols, such as those from the Human Milk Banking Association of North America (http://www.hmbana.org/). The treatment and overall processing of the milk affects the protection afforded human milk. Indeed, NICU infants receiving pasteurized donor milk plus infant formula had significantly greater infectious morbidity than those receiving either a sole diet of pasteurized milk, or

Human milk fortification

The nutrient deficits that arise from feeding unfortified human milk can be corrected with nutrient supplementation. Protein and energy supplementations are associated with improved rates of weight gain, nitrogen balance, and indices of protein nutritional status: blood urea nitrogen, serum albumin, total protein, and transthyretin [19], [37]. The efficacy of protein fortification of human milk (∼ 1.5 g protein/kg/day added to human milk) was of short-term benefit resulting in increases in

Effects of fortified human milk on infectious morbidity

A theoretical concern with human milk fortification is that the added nutrients may affect the intrinsic host defense system of the milk. Fortunately, this has not been the published experience. In a retrospective review of cases, premature infants fed fortified human milk had a 26% incidence of documented infection compared with 49% in formula-fed infants [45]. Results of a randomized trial of multi-nutrient fortified human milk indicated no increase in either confirmed infection or NEC

Effects of human milk on neurodevelopmental outcome

A meta-analysis of breast-feeding and cognitive development suggests that beneficial effects are small but significantly favor breast-feeding [54]. Several reports suggest that the diet in the NICU might affect long-term neurodevelopmental outcomes in premature infants. An 8 year follow-up of 300 premature infants (approximately 1.4 kg and 31 weeks gestation at birth) observed that when factors affecting intelligence quotient (social class, maternal education, infant gender, and duration of

Effects of human milk on feeding tolerance

Infants fed their mother's own milk fortified with commercial fortifiers achieved full enteral feedings significantly earlier than those infants receiving preterm formula [48]. Feeding tolerance and time to tolerate full feedings were evaluated in 2 studies where premature infants fed pasteurized donor milk had less feeding intolerance (2.4% vs. 23%) and took more than 3 weeks to tolerate full feedings (5% vs. 17%) than formula, respectively [20], [63].

Clinicians have questioned whether the

In-hospital feeding practices

The use of multi-nutrient fortification of human milk for premature infants born weighing less than 1500 g is recommended [68], [69], [70]. It is noteworthy that human milk fortifiers, more so than preterm formulas, differ in their nutrient contents throughout the world. A fortifier should be chosen that provides at minimum a multi-nutrient mixture, including protein, fat, calcium, phosphorus, zinc, sodium, iron, and multivitamins. A variety of protocols are used for feeding fortified human

Summary

Human milk feeding is associated with substantial benefits to the premature infants' health. Mother's own milk with nutrient supplementation is associated with reduced infectious and inflammatory disease, enhanced neurodevelopmental outcome, and, in a carefully designed nutritional program, is associated with healthy early postnatal growth patterns. Donor milk, because of the manner in which it is collected, processed, and stored substantially diminishes the advantages ascribed to mother's own

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