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Fortification of Human Milk in the Neonatal Intensive Care Unit

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (31 March 2020) | Viewed by 14409

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Dr. Elizabeth A. Brownell

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Guest Editor

School of Nursing, University of Texas Health Science Center, San Antonio,TX 78229,USA
Interests: human milk; fortification; preterm infants; neonatal intensive care unit; nutrition

Special Issue Information

Dear Colleagues,

This special issue is dedicated to fortification of human milk in the NICU. In particular, we are interested in assessing the association between fortification of mother’s own milk and/or donor human milk and in-patient clinical outcomes, discharge outcomes, and/or long-term growth and/or neurodevelopment outcomes. Studies of interest for this special issue should include exposures of standard fortification, adjusted fortification, targeted fortification, or a combination of fortification methods. Given that fortification protocols are specific to each institution, we appreciate detailed information on fortification processes and any measurements of human milk prior/post fortification.

Dr. Elizabeth A. Brownell
Guest Editor

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Keywords

Human milk
Fortification
Preterm infants
Neonatal intensive care unit
Nutrition

Published Papers (5 papers)

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Research

13 pages, 954 KiB

Open AccessArticle

Factors in Early Feeding Practices That May Influence Growth and the Challenges That Arise in Growth Outcomes Research

by Veronica Fabrizio, Veronika Shabanova and Sarah N. Taylor

Nutrients 2020, 12(7), 1939; https://doi.org/10.3390/nu12071939 - 30 Jun 2020

Cited by 4 | Viewed by 2362

Abstract

Growth in preterm infants is associated with improved outcomes during both the initial hospitalization and long-term. A single center investigation evaluated preterm infant in-hospital growth trajectory and how it related to early nutritional practices as a way to identify areas for quality improvement. Infants born <34 weeks’ gestational age and with discharge at or prior to 40 weeks’ gestational age were included and were divided into quartiles based on their change in weight z-score through hospitalization. Early nutritional factors were compared between the lowest and highest growth quartiles. Although the highest growth quartile experienced less days of parenteral nutrition and higher enteral caloric density in the first week, as the data was analyzed, potential statistical pitfalls became apparent. Therefore, the aim of this study was to investigate selection bias and cohort effect related to both the inclusion criteria for this cohort as well as the inherent challenges in comparison of preterm infant growth trajectories by standard fetal growth charts. Full article

(This article belongs to the Special Issue Fortification of Human Milk in the Neonatal Intensive Care Unit)

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9 pages, 876 KiB

Open AccessArticle

Role of the Proportional Intake of Fortified Mother’s Own Milk in the Weight Gain Pattern of Their Very-Preterm-Born Infants

by Anna Petrova, Shannon Eccles and Rajeev Mehta

Nutrients 2020, 12(6), 1571; https://doi.org/10.3390/nu12061571 - 28 May 2020

Cited by 4 | Viewed by 2057

Abstract

Breastfeeding has been recommended for preterm infants as the optimal diet from nutritional, gastrointestinal, immunological, and developmental perspectives. However, the relevance of differing intakes of fortified mother’s own milk (MOM) on the growth of their preterm infants is a challenging question because of the potential risk of extrauterine growth impairment, apart from its essential role in the provision of biological and immunological factors, and the reduction of serious morbidities. We aimed to identify the weight gain pattern in very-preterm-born infants with respect to their proportional intake of fortified MOM. The daily and average weight gain, dietary volume, calories, and proportional intake of fortified MOM were studied in a cohort of 84 very-preterm-born infants during the first 2 weeks post initiation of full enteral feeds. Groups 1, 2, and 3 were comprised of infants with a proportional fortified MOM intake of 85% or more, 35% to 84.9%, and 0 to 34.9%, respectively. Data analysis included regression models and a group-based comparison of the number of infants with weight gain that would be considered minimally acceptable for normal intrauterine growth. The infants’ weight gain was not found to be associated with the proportional intake of fortified MOM or other feeding parameters. Overall, the intergroup variability in the proportion of infants with weight gain less than the lower limit of normal fetal growth was insignificant. During the first 2 weeks post initiation of full enteral feeds, the weight gain pattern of the studied very-preterm-born infants was not significantly dependent on the proportional intake of fortified maternal milk. Full article

(This article belongs to the Special Issue Fortification of Human Milk in the Neonatal Intensive Care Unit)

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9 pages, 421 KiB

Open AccessArticle

Calculating Protein Content of Expressed Breast Milk to Optimize Protein Supplementation in Very Low Birth Weight Infants with Minimal Effort—A Secondary Analysis

by Michaela Minarski, Christoph Maas, Corinna Engel, Christine Heinrich, Katrin Böckmann, Wolfgang Bernhard, Christian F Poets and Axel R Franz

Nutrients 2020, 12(5), 1231; https://doi.org/10.3390/nu12051231 - 27 Apr 2020

Cited by 6 | Viewed by 3038

Abstract

Breast milk does not meet the nutritional needs of preterm infants, necessitating fortification. Breast milk is particularly variable in protein content, hence standardized (fixed dosage) supplementation results in inadequate supply. This was a secondary analysis of 589 breast milk protein content measurements of 51 mothers determined by mid-infrared spectroscopy during a clinical trial of higher versus lower protein supplementation in very low birth weight infants. Mothers (and breast milk samples) were divided into a test (41 mothers) and a validation cohort (10 mothers). In the test cohort, the decrease in protein content by day of lactation was modeled resulting in the breast milk-equation (BME)). In the validation cohort, five supplementation strategies to optimize protein supply were compared: standardized supplementation (adding 1.0 g (S1) or 1.42 g protein/100 mL (S2)) was compared with ‘adapted’ supplementation, considering variation in protein content (protein content according to Gidrewicz and Fenton (A1), to BME (A2) and to BME with adjustments at days 12 and 26 (A3)). S1 and S2 achieved 5% and 24% of adequate protein supply, while the corresponding values for A1–A3 were 89%, 96% and 95%. Adapted protein supplementation based on calculated breast milk protein content is easy, non-invasive, inexpensive and improves protein supply compared to standardized supplementation. Full article

(This article belongs to the Special Issue Fortification of Human Milk in the Neonatal Intensive Care Unit)

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11 pages, 358 KiB

Open AccessArticle

Targeted Breast Milk Fortification for Very Low Birth Weight (VLBW) Infants: Nutritional Intake, Growth Outcome and Body Composition

by Sumesh Parat, Praneeta Raza, May Kamleh, Dennis Super and Sharon Groh-Wargo

Nutrients 2020, 12(4), 1156; https://doi.org/10.3390/nu12041156 - 21 Apr 2020

Cited by 17 | Viewed by 3678

Abstract

Despite improvements in nutritional management, preterm infants continue to face high rates of postnatal growth restriction. Because variability in breast milk composition may result in protein and energy deficits, targeted fortification has been advocated. We conducted an interventional study to compare body composition and growth outcomes of very low birth weight infants fed targeted protein-fortified human milk (HM) with those fed standard fortified HM. If mother’s own milk was not available, donor milk was used. Weekly analysis of HM with mid-infrared spectroscopy was conducted and additional protein was added to the fortified HM to ensure a protein intake of 4 g/kg/day. Weekly anthropometric measurements were done. Prior to discharge or at 37 weeks, corrected age skinfold thickness (SFT) measurements as well as body composition measurement using air displacement plethysmography were done. Among 36 preterm infants enrolled, those in the targeted group (n = 17) received more protein and had a larger flank SFT at study end than those in the standard group (n = 19). A pilot post-hoc analysis of subjects having at least 30 intervention days showed a 3% higher fat-free mass in the targeted group. Use of a targeted fortification strategy resulted in a higher protein intake and fat-free mass among those receiving longer intervention. Full article

(This article belongs to the Special Issue Fortification of Human Milk in the Neonatal Intensive Care Unit)

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13 pages, 1893 KiB

Open AccessArticle

Impact of Donor Human Milk in the Preterm Very Low Birth Weight Gut Transcriptome Profile by Use of Exfoliated Intestinal Cells

by Anna Parra-Llorca, María Gormaz, Sheila Lorente-Pozo, Maria Cernada, Ana García-Robles, Isabel Torres-Cuevas, Julia Kuligowski, Maria Carmen Collado, Eva Serna and Máximo Vento

Nutrients 2019, 11(11), 2677; https://doi.org/10.3390/nu11112677 - 5 Nov 2019

Cited by 6 | Viewed by 2824

Abstract

Background: Own mother’s milk (OMM) is the optimal nutrition for preterm infants. However, pasteurized donor human milk (DHM) is a valid alternative. We explored the differences of the transcriptome in exfoliated epithelial intestinal cells (EEIC) of preterm infants receiving full feed with OMM or DHM. Methods: The prospective observational study included preterm infants ≤ 32 weeks’ gestation and/or ≤1500 g birthweight. Total RNA from EEIC were processed for genome-wide expression analysis. Results: Principal component analysis and unsupervised hierarchical clustering analysis revealed two clustered groups corresponding to the OMM and DHM groups that showed differences in the gene expression profile in 1629 transcripts. The OMM group overexpressed lactalbumin alpha gene (LALBA), Cytochrome C oxidase subunit I gene (COX1) and caseins kappa gene (CSN3), beta gene (CSN2) and alpha gene (CSN1S1) and underexpressed Neutrophil Cytosolic Factor 1 gene (NCF1) compared to the DHM group. Conclusions: The transcriptomic analysis of EEIC showed that OMM induced a differential expression of specific genes that may contribute to a more efficient response to a pro-oxidant challenge early in the postnatal period when preterm infants are at a higher risk of oxidative stress. The use of OMM should be strongly promoted in preterm infants. Full article

(This article belongs to the Special Issue Fortification of Human Milk in the Neonatal Intensive Care Unit)

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