Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Preterm infants fed fortified human milk receive less protein than they need



The aim of this study was to compare the actual nutrient intakes observed in a previously reported study with assumed nutrient intakes based on the customary assumptions about the composition of human milk.

Study Design:

Fortified human milk is assumed to provide adequate amounts of nutrients for premature infants. This assumption holds if milk has the composition of milk expressed by mothers of premature infants during weeks 2 to 3 of lactation. The assumption does not necessarily hold for milk expressed after 2 to 3 weeks lactation. It also does not hold for donor milk, which is typically provided by mothers of term infants. The size of the disparity between assumed and actual nutrient intakes is not known. Actual nutrient intakes were available for 32 preterm infants participating in the study. Assumed nutrient intakes were calculated for these infants by substituting assumed nutrient concentrations for observed nutrient concentrations. Data were compared separately for each of the 3 study weeks.


Actual protein intakes were significantly and consistently lower than assumed protein intakes during each study week. The differences in mean intakes were large, ranging from 0.5 to 0.8 g kg−1 per day. Differences in energy intake were small and not consistently significant.


Actual intakes of protein by preterm infants fed fortified human milk are substantially lower than assumed intakes. The discrepancy may in part explain why preterm infants frequently show postnatal growth failure.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Blaymore Bier J, Oliver T, Ferguson A, Vohr BR . Human milk reduces outpatient upper respiratory symptoms in premature infants during their first year of life. J Perinatol 2002; 22: 354–359.

    Article  Google Scholar 

  2. Hylander MA, Strobino DM, Dhanirreddy R . Human milk feedings and infection among VLBW infants. Pediatrics 1998; 102 (3): E8

  3. Rønnestad A, Abrahamsen TG, Medbø S, Reigsatd H, Lossius K, Kaaresen PI et al. Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics 2005; 115: e269–e276.

    Article  Google Scholar 

  4. Lucas A, Cole TJ . Breast milk and neonatal necrotising enterocolitis. Lancet 1990; 336: 1519–1523.

    Article  CAS  Google Scholar 

  5. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O'Shea TM . Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol 2007; 27: 428–433.

    Article  CAS  Google Scholar 

  6. Quigley MA, Henderson G, Anthony MY, McGuire W . Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2007; 17 (4): CD002971.

    Google Scholar 

  7. Henderson G, Anthony MY, McGuire W . Formula milk versus maternal breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2007; 17 (4): CD002972.

    Google Scholar 

  8. Anderson JW, Johnstone BM, Remley DT . Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999; 70: 525–535.

    Article  CAS  Google Scholar 

  9. Bier JA, Oliver T, Ferguson AE, Vohr BR . Human milk improves cognitive and motor development of premature infants during infancy. J Hum Lact 2002; 18: 361–367.

    Article  Google Scholar 

  10. Feldman R, Eidelman AI . Direct and indirect effects of breast-milk on the neurobehavioral and cognitive development of premature infants. Dev Psychobiol 2003; 43: 109–119.

    Article  Google Scholar 

  11. Lucas A, Morley R, Cole TJ, Gore SM . A randomised multicentre study of human milk versus formula and later development in preterm infants. Arch Dis Child 1994; 70: F141–F146.

    Article  CAS  Google Scholar 

  12. Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Wright LL, Langer JC et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcomes of extremely birth weight infants at 18 months of age. Pediatrics 2006; 118: e115–e123.

    Article  Google Scholar 

  13. Ziegler EE . Breast-milk fortification. Acta Paediatr 2001; 90: 720–723.

    Article  CAS  Google Scholar 

  14. Kuschel CA, Harding J . Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database Syst Rev 2004, Cochrane Library. 2004; 1: CD000343.

  15. Lemons JA, Moye L, Hall D, Simmons M . Differences in the composition of preterm and term human milk during early lactation. Pediatr Res 1982; 16: 113–117.

    Article  CAS  Google Scholar 

  16. Polberger S, Raiha NCR, Juvonen P, Moro GE, Minoli I, Warm A . Individualized protein fortification of human milk for preterm infants: comparison of ultrafiltrated human milk protein and a bovine whey fortifier. J Pediatr Gastroenterol Nutr 1999; 29: 332–338.

    Article  CAS  Google Scholar 

  17. Michaelsen KF, Skafte L, Badsberg JH, Jørgensen M . Variation in macronutrients in human bank milk: influencing factors and implications for human milk banking. J Pediatr Gastroenterol Nutr 1990; 11: 229–239.

    Article  CAS  Google Scholar 

  18. Arslanoglu S, Moro GE, Ziegler EE . Adjustable fortification of human milk fed to preterm infants: does it make a difference? J Perinatol 2006; 26 (10): 614–621.

    Article  CAS  Google Scholar 

  19. Gross SJ, Geller J, Tomarelli RM . Composition of breast milk from mothers of preterm infants. Pediatrics 1981; 68: 490–493.

    CAS  Google Scholar 

  20. Weber A, Loui A, Jochum F, Bührer C, Obladen M . Breast milk from mothers of very low birth weight infants: variability in fat and protein content. Acta Paediatr 2001; 90: 772–775.

    Article  CAS  Google Scholar 

  21. Carlson SJ, Ziegler EE . Nutrient intakes and growth of very low birth weight infants. J Perinatol 1998; 18: 252–258.

    CAS  Google Scholar 

  22. Olsen IE, Richardson DK, Schmid CH, Ausman LM, Dwyer JT . Intersite differences in weight growth velocity of extremely premature infants. Pediatrics 2002; 110: 1125–1132.

    Article  Google Scholar 

  23. Embleton NE, Pang N, Cooke RJ . Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2003; 107: 270–273.

    Article  Google Scholar 

  24. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK . Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117: 1253–1261.

    Article  Google Scholar 

  25. Kashyap S, Schulze KF, Ramakrishnan R, Dell RB, Heird WC . Evaluation of a mathematical model for predicting the relationship between protein and energy intakes of low-birth-weight infants and the rate and composition of weight gain. Pediatr Res 1994; 35 (6): 704–712.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to S Arslanoglu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Arslanoglu, S., Moro, G. & Ziegler, E. Preterm infants fed fortified human milk receive less protein than they need. J Perinatol 29, 489–492 (2009).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • human milk fortification
  • adjustable fortification
  • protein intake
  • breast milk fortification
  • neonatal nutrition
  • preterm

This article is cited by


Quick links