Fortifying breast milk is a process of adding extra nutrients to breast milk to provide additional nourishment for babies. This is often done to meet the nutritional needs of premature or low birth weight infants who require more calories and nutrients than what breast milk alone can provide.
Breast milk fortifiers are commercially available in liquid and powder form. These fortifiers are added to expressed breast milk to increase the amount of protein, calories, and other nutrients. The fortified breast milk can then be fed to the baby through a bottle or feeding tube.
Fortifying breast milk is recommended by healthcare professionals as the first-line treatment for increasing calories in babies under six months of age. It allows the baby to still receive all the benefits of breast milk plus additional nutrients, as opposed to the exclusive use of formula first. However, it is important to note that the decision to fortify breast milk should be made in consultation with a healthcare provider, as the amount and type of fortification needed can vary depending on the baby's individual needs.
Understanding Breast Milk and Its Components
Breast milk is the ideal source of nutrition for infants. It contains a unique blend of macronutrients, micronutrients, and bioactive compounds that support the growth and development of the infant. In this section, we will discuss the composition of breast milk, the nutritional needs of infants, and the benefits of human milk for growth and development.
The Composition of Breast Milk
Breast milk is a complex fluid that contains a variety of components, including proteins, carbohydrates, lipids, vitamins, minerals, and other bioactive compounds. The composition of breast milk changes over time to meet the changing nutritional needs of the infant. For example, colostrum, the first milk produced by the mother, is rich in proteins and antibodies that help protect the newborn from infections. As lactation progresses, the milk becomes higher in fat content, which provides the infant with the energy needed for growth.
Breast milk also contains a variety of minerals, including calcium and iron, which are essential for the growth and development of the infant. Vitamin D is also present in breast milk, but the amount is often not sufficient to meet the infant's needs. Therefore, the American Academy of Pediatrics recommends that breastfed infants receive a vitamin D supplement.
Nutritional Needs of Infants
Infants have unique nutritional needs that are different from those of older children and adults. During the first six months of life, infants require a high amount of energy and protein to support their rapid growth and development. Breast milk provides all the necessary nutrients for the infant during this time, including carbohydrates, proteins, and fats.
Benefits of Human Milk for Growth and Development
Breast milk provides a variety of benefits for the growth and development of the infant. Studies have shown that breastfed infants have a lower risk of infections, allergies, asthma, and other health problems compared to formula-fed infants. Breast milk also contains bioactive compounds, such as growth factors and hormones, that promote the development of the infant's organs and tissues.
In conclusion, breast milk is the optimal source of nutrition for infants. It contains a unique blend of macronutrients, micronutrients, and bioactive compounds that support the growth and development of the infant. Breastfeeding provides a variety of benefits for the infant's health and well-being.
The Importance of Fortification for Preterm Infants
Preterm infants, especially those with low birth weight, face numerous challenges to their health and development. One of the biggest challenges is meeting their nutritional needs, as they have higher nutrient requirements than full-term infants. Fortifying human milk with a human milk fortifier (HMF) can help meet these needs and improve growth outcomes.
Challenges Faced by Preterm and Low Birth Weight Infants
Preterm infants are born before 37 weeks of gestational age, and low birth weight infants weigh less than 2500 grams at birth. Very low birth weight infants weigh less than 1500 grams. These infants are at higher risk of growth restriction and have higher nutrient requirements than full-term infants. They are also more vulnerable to infections and other health complications.
Role of Human Milk Fortifiers in Growth Outcomes
Human milk is the preferred feeding source for preterm infants, as it provides numerous health benefits. However, it may not provide sufficient nutrients to meet the needs of preterm infants. HMFs are designed to supplement the nutrient content of human milk and improve growth outcomes.
Studies have shown that fortifying human milk with HMFs can significantly improve weight gain and head circumference in preterm infants. It can also reduce the risk of complications such as necrotizing enterocolitis and sepsis. HMFs are typically added to human milk once the infant is discharged from the hospital and continue until the infant reaches a certain weight or age.
In conclusion, fortifying human milk with HMFs is an important strategy to improve the nutritional status and growth outcomes of preterm infants. It is important to ensure that preterm infants receive adequate nutrition to support their health and development.
Types of Breast Milk Fortifiers
Breast milk fortifiers are used to supplement the nutritional content of breast milk for preterm infants. There are two main types of breast milk fortifiers: multi-nutrient and human milk-based vs. cow's milk-based fortifiers.
Multi-Nutrient Fortifiers
Multi-nutrient fortifiers are the most commonly used type of breast milk fortifiers. They contain a blend of essential vitamins, minerals, and nutrients that are necessary for the growth and development of preterm infants. These fortifiers are available in both powder and liquid forms and can be added to breast milk to increase its nutritional content.
Human Milk-Based vs. Cow's Milk-Based Fortifiers
Human milk-based fortifiers are made from donor breast milk and are considered the gold standard for breast milk fortification. They contain a blend of essential nutrients that are similar to those found in breast milk, making them easier for preterm infants to digest and absorb. These fortifiers are also less likely to cause allergic reactions or other adverse effects.
Cow's milk-based fortifiers, on the other hand, are made from cow's milk and are fortified with additional nutrients. While these fortifiers are effective in increasing the nutritional content of breast milk, they are also associated with a higher risk of contamination and may cause allergic reactions or other adverse effects in some preterm infants.
In summary, breast milk fortifiers are an important tool for ensuring the optimal growth and development of preterm infants. Multi-nutrient fortifiers are the most commonly used type of breast milk fortifiers, while human milk-based fortifiers are considered the gold standard. Cow's milk-based fortifiers are also effective but may be associated with a higher risk of adverse effects.
Methods of Fortification
Breast milk fortification is a process of adding extra nutrients to breast milk to meet the nutritional needs of preterm infants. There are two methods of fortification that are commonly used: adjustable fortification and standard fortification practices.
Adjustable Fortification
Adjustable fortification is a method that allows for personalized fortification of breast milk based on the individual needs of the infant. This method involves adding a nutrient supplement, usually in the form of a powder, to the breast milk. The amount of supplement added is adjusted based on the infant's weight, gestational age, and nutritional needs. This method is preferred over standard fortification practices as it allows for more tailored nutrition for the infant.
Standard Fortification Practices
Standard fortification practices involve adding a fixed amount of nutrient supplement to breast milk. This method is commonly used in hospitals and neonatal intensive care units (NICUs) where adjustable fortification may not be feasible. The nutrient supplement is usually added in powder form and can include iron supplements, vitamins, and minerals.
Both methods of fortification have been shown to improve the growth and nutritional status of preterm infants. However, adjustable fortification is preferred as it allows for more individualized nutrition and has been associated with better outcomes in preterm infants.
In conclusion, fortification of human milk is a crucial step in ensuring the optimal growth and development of preterm infants. The choice of method depends on the individual needs of the infant and the resources available. Adjustable fortification is preferred over standard fortification practices as it allows for more personalized nutrition for the infant.
Monitoring and Outcomes of Fortification
Fortification of breast milk is a common practice to provide preterm infants with the necessary nutrients to support growth and development. Monitoring growth outcomes is essential to ensure that the fortification is providing adequate nutrition.
Assessing Growth and Development
Growth outcomes are typically monitored using weight gain, head circumference, and body composition measurements. A study by the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification found that fortification of breast milk post-discharge improved nutritional status as well as growth in preterm infants. The study also found that the fortification of breast milk from discharge to four months corrected age improved growth outcomes [1].
Head circumference is another important measurement in monitoring growth outcomes in preterm infants. A study on the effect of human milk-based fortification in extremely preterm infants found that head circumference growth was similar between the human milk-based fortification group and the bovine-based fortification group [2].
Dual energy X-ray absorptiometry (DEXA) is a tool that can be used to measure bone mineralization in preterm infants. A study on human milk fortification found that preterm infants who received fortified breast milk had improved bone mineralization compared to those who received unfortified breast milk [3].
Neurodevelopmental and Health Outcomes
Neurodevelopmental outcomes are also important to consider when monitoring the effects of fortification on preterm infants. A study on the use of human milk and fortification in the NICU found that adjustable fortification using blood urea nitrogen as a surrogate for protein intake improved neurodevelopmental outcomes in preterm infants [4].
Cardiovascular health and diabetes risk are also important health outcomes to consider when monitoring the effects of fortification on preterm infants. A review of the literature on human milk fortification found that there is limited evidence on the effects of fortification on cardiovascular health and diabetes risk in preterm infants [3].
In summary, monitoring growth outcomes, head circumference, body composition, bone mineralization, neurodevelopmental outcomes, cardiovascular health, and diabetes risk are important when assessing the effects of fortification on preterm infants. While there is limited evidence on the effects of fortification on cardiovascular health and diabetes risk, studies have shown that fortification improves growth outcomes and bone mineralization, and adjustable fortification improves neurodevelopmental outcomes.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439523/ [2] https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00552-7/fulltext [3] https://www.perinatology.theclinics.com/article/S0095-5108(22)00024-0/fulltext [4] https://www.nature.com/articles/s41372-022-01532-0
