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Dilemmas in human milk fortification


Fortification of human milk is the standard of care for very low birth weight (VLBW) infants and is required to support adequate postnatal growth and development. Achieving adequate growth velocity and preventing growth faltering is critical for the developing neonatal brain and optimizing long-term neurodevelopmental outcomes. Mother’s milk is the gold standard nutrition to feed preterm infants, however, it does not provide the nutrients needed to support the growth of VLBW infants. After the decision is made to use mother’s milk (if available) or alternatively, donor human milk, many dilemmas exist with regards to additional treatment decisions surrounding the type of fortification to use, when to fortify, and the duration of fortification. In this article, we will review the differences in mother’s milk compared to donor milk, the different types of human milk fortifiers, the optimal timing of fortification, and discuss when to discontinue human milk fortification.

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Fig. 1: Dilemmas clinicians face when choosing which fortifier to use for very low birth weight infants.


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BS is supported by Gerber Foundation grant #21-6234 and a grant from Evolve Biosystems. ABH and MG are supported by the National Institutes of Health (NIH) grant R01DK124614, and MG is also supported by NIH grants R01DK118568 and R01HD105301. None of the funding sources had any role in this manuscript.

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ABH, BS, and MG wrote the initial and final drafts of the manuscript, approved the final published version, and are accountable for all aspects of the manuscript.

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Correspondence to Misty Good.

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Hair, A.B., Scottoline, B. & Good, M. Dilemmas in human milk fortification. J Perinatol (2022).

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