Human milk fortification: the clinician and parent perspectives

Abstract

This study reports on the human milk fortification session at the 2019 NEC Society Symposium, which included clinicians and parents discussing the evidence comparing fortification options such as efficacy, safety, cost effectiveness, and the need for parents to be informed about fortifier choice. With the current literature available and the varying standard of care practices for human milk fortification, further studies are needed to determine the most complete diet for preterm infants. The optimal diet would not only provide key nutrients and energy for growth and development, but also improve short- and long-term outcomes. Parents, as advocates and providers for their infant, should be informed, educated, and included in the discussion and decisions regarding fortification of human milk for their infant.

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References

  1. 1.

    Shah, P. S. et al. Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome. J. Perinat. Med. 34, 484–489 (2006).

    Article  Google Scholar 

  2. 2.

    Ehrenkranz, R. A. et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 117, 1253–1261 (2006).

    Article  Google Scholar 

  3. 3.

    Belfort, M. B. et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 128, e899–e906 (2011).

    Article  Google Scholar 

  4. 4.

    Zozaya, C., Diaz, C. & Saenz de Pipaon, M. How should we define postnatal growth restriction in preterm infants? Neonatology 114, 177–180 (2018).

    Article  Google Scholar 

  5. 5.

    Franz, A. R. et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 123, e101–e109 (2009).

    Article  Google Scholar 

  6. 6.

    Taylor, S. N., Basile, L. A., Ebeling, M. & Wagner, C. L. Intestinal permeability in preterm infants by feeding type: mother’s milk versus formula. Breastfeeding medicine: the official journal of the Academy of Breastfeeding. Medicine 4, 11–15 (2009).

    Google Scholar 

  7. 7.

    Friel, J. K. et al. Evidence of oxidative stress in relation to feeding type during early life in premature infants. Pediatr. Res. 69, 160–164 (2011).

    CAS  Article  Google Scholar 

  8. 8.

    Jocson, M. A., Mason, E. O. & Schanler, R. J. The effects of nutrient fortification and varying storage conditions on host defense properties of human milk. Pediatrics 100(Part 1), 240–243 (1997).

    CAS  Article  Google Scholar 

  9. 9.

    Schanler, R. J., Shulman, R. J. & Lau, C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 103(Part 1), 1150–1157 (1999).

    CAS  Article  Google Scholar 

  10. 10.

    Furman, L., Taylor, G., Minich, N. & Hack, M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch. Pediatr. Adolesc. Med. 157, 66–71 (2003).

    Article  Google Scholar 

  11. 11.

    Meinzen-Derr, J. et al. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. J. Perinatol. 29, 57–62 (2009).

    CAS  Article  Google Scholar 

  12. 12.

    Sisk, P. M., Lovelady, C. A., Dillard, R. G., Gruber, K. J. & O’Shea, T. M. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J. Perinatol. 27, 428–433 (2007).

    CAS  Article  Google Scholar 

  13. 13.

    Quigley, M., Embleton, N. D. & McGuire, W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst. Rev. 6, CD002971 (2018).

    PubMed  Google Scholar 

  14. 14.

    Arthur I. E. et al. Breastfeeding and the use of human milk. Pediatrics 129, e827–e841 (2012).

  15. 15.

    Arslanoglu, S. et al. Donor human milk for preterm infants: current evidence and research directions. J. Pediatr. Gastroenterol. Nutr. 57, 535–542 (2013).

    Article  Google Scholar 

  16. 16.

    Fleurant, E. et al. Barriers to human milk feeding at discharge of very-low-birth-weight infants: maternal goal setting as a key social factor. Breastfeed. Med. 12, 20–27 (2017).

    Article  Google Scholar 

  17. 17.

    Meier, P. P., Johnson, T. J., Patel, A. L. & Rossman, B. Evidence-based methods that promote human milk feeding of preterm infants: an expert review. Clin. Perinatol. 44, 1–22 (2017).

    Article  Google Scholar 

  18. 18.

    O’Connor, D. L. et al. Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula. J. Pediatr. Gastroenterol. Nutr. 37, 437–446 (2003).

    Article  Google Scholar 

  19. 19.

    Alpay, F. et al. Measurement of bone mineral density by dual energy X-ray absorptiometry in preterm infants fed human milk or formula. Eur. J. Pediatr. 157, 505–507 (1998).

    CAS  Article  Google Scholar 

  20. 20.

    Agostoni, C. et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 50, 85–91 (2010).

    CAS  Article  Google Scholar 

  21. 21.

    Brown, J. V., Embleton, N. D., Harding, J. E. & McGuire, W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst. Rev. 5, Cd000343 (2016).

    Google Scholar 

  22. 22.

    Polberger, S. K., Axelsson, I. A. & Raiha, N. C. Growth of very low birth weight infants on varying amounts of human milk protein. Pediatr. Res. 25, 414–419 (1989).

    CAS  Article  Google Scholar 

  23. 23.

    Sullivan, S. et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J. Pediatr. 156, 562–567.e561 (2010).

    CAS  Article  Google Scholar 

  24. 24.

    Cristofalo, E. A. et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J. Pediatr. 163, 1592–1595 e1591 (2013).

    Article  Google Scholar 

  25. 25.

    Hair, A. B. et al. Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet. Breastfeed. Med. 11, 70–74 (2016).

    Article  Google Scholar 

  26. 26.

    O’Connor, D. L. et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am. J. Clin. Nutr. 108, 108–116 (2018).

    Article  Google Scholar 

  27. 27.

    Abrahamsson, T. R. et al. Human milk fortification in extremely preterm infants (Nordic Trial). https://clinicaltrials.gov/ct2/show/NCT03797157.

  28. 28.

    Assad, M., Elliott, M. J. & Abraham, J. H. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet. J. Perinatol. 36, 216–220 (2016).

    CAS  Article  Google Scholar 

  29. 29.

    Ganapathy, V., Hay, J. W. & Kim, J. H. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants. Breastfeed. Med. 7, 29–37 (2012).

    Article  Google Scholar 

  30. 30.

    Parker, M. G. et al. Prevalence and predictors of donor milk programs among U.S. advanced neonatal care facilities. J Perinatol. 40, 672–680 (2020).

    Article  Google Scholar 

  31. 31.

    Norberg, S. et al. Cronobacter spp. in powdered infant formula. J. Food Prot. 75, 607–620 (2012).

    CAS  Article  Google Scholar 

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Acknowledgements

Publication of this article was sponsored by the Necrotizing Enterocolitis (NEC) Society, Patient-Centered Outcomes Research Institute, and National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development and The Texas Children’s Hospital Neonatal Nutrition Research Program.

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A.B.H., J.F., C.G., J.H.K., and S.N.T. made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. All authors were involved in drafting the article or revising it critically for important intellectual content and provided final approval of the manuscript.

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Correspondence to Amy B. Hair.

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Competing interests

A.B.H. received grant support for unrelated studies from Prolacta Bioscience, Fresenius-Kabi, and the Gerber Foundation. J.H.K. received grant support from Mallinckrodt and Fresenius-Kabi, received consultant or advisor fees from Evolve Bioscience, Medela, Alcresta, Ferring, received lecture fees from Mead Johnson Nutrition, Abbott Nutrition, owns shares in Pediasolutions, Nicolette and Astarte Medical, served as expert witness, and holds a patent for a newborn heart rate device. S.N.T. received unrelated grant support from Allen Foundation, National Institute of Health, Mallinckrodt, and Prolacta Bioscience. J.F. and C.G. declared no competing interests.

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Hair, A.B., Ferguson, J., Grogan, C. et al. Human milk fortification: the clinician and parent perspectives. Pediatr Res 88, 25–29 (2020). https://doi.org/10.1038/s41390-020-1076-2

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