The role of breast milk fortifier in the post-discharge nutrition of preterm infants

Infants born prematurely are often discharged from hospital before 37 weeks post-menstrual age. While breastfeeding will meet all the nutritional requirements of full-term infants, these preterm infants may need enhanced levels of protein, minerals and possibly energy to ensure optimum growth, bone mineralisation and neurological development. To meet these additional nutrient needs in the neonatal unit, it is currently recommended that multinutrient breast milk fortifier is added to maternal breast milk. There may also be benefits in continuing to provide fortified milk after discharge, potentially including improved growth and preserving breastfeeding, and this is increasingly becoming a recognised practice in some neonatal units. This article presents the discussion and consensus of a multidisciplinary panel of neonatologists, neonatal dietitians, a GP and a neonatal outreach sister. The aim is to develop guidance on providing safe and effective nutritional supplementation for preterm infants after discharge in order to maintain optimal growth. This guidance is aimed at community healthcare staff and is based on the limited evidence available, using shared best practice and expertise.

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Post-discharge formula feeding in preterm infants: A systematic review mapping evidence about the role of macronutrient enrichment

Clinical Nutrition ◽

10.1016/j.clnu.2015.08.006 ◽

2016 ◽

Vol 35 (4) ◽

pp. 791-801 ◽

Cited By ~ 18

Author(s):

Inga C. Teller ◽

Nicholas D. Embleton ◽

Ian J. Griffin ◽

Ruurd M. van Elburg

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Formula Feeding ◽

Post Discharge

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Supporting Mothers of Very Preterm Infants and Breast Milk Production: A Review of the Role of Galactogogues

Nutrients ◽

10.3390/nu10050600 ◽

2018 ◽

Vol 10 (5) ◽

pp. 600 ◽

Cited By ~ 3

Author(s):

Elizabeth Asztalos

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Milk Production ◽

Very Preterm Infants ◽

Very Preterm ◽

Breast Milk Production

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The Role of User Ownership and Positive User Attitudes in the Successful Adoption in Information Systems within NHS Community Trusts

Effective Healthcare Information Systems ◽

10.4018/978-1-931777-01-8.ch007 ◽

2011 ◽

pp. 113-137

Author(s):

Crispin R. Coombs ◽

Neil F. Doherty ◽

John Loan-Clarke

Keyword(s):

Best Practice ◽

Academic Research ◽

Community Healthcare ◽

System A ◽

User Attitudes ◽

Two Factors ◽

Multiple Case ◽

Organizational Sector

The factors that influence the ultimate level of success or failure of systems development projects have received considerable attention in the academic literature. However, despite the existence of a ‘best practice’ literature many projects still fail. The record of the National Health Service has been particularly poor in this respect. The research reported in this paper proposes that two additional factors; user ownership and positive user attitudes warrant further development and investigation. The current study investigated these two factors in a homogenous organizational sector, Community NHS Trusts, using a common type of information system, in order to eliminate the potentially confounding influences of sector and system. A multiple case-study design incorporating five Community Healthcare Trusts was utilized. The key results from the analysis indicated that both user ownership and positive user attitudes were important mediating variables that were crucial to the success of a CIS. In addition, it was also identified that the adoption of best practice variables had a dual role, directly influencing the level of perceived success but also facilitating the development of user ownership and positive user attitudes. These results will be of particular interest to practising IM&T managers in the NHS and also to the wider academic research community.

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Body Composition in Very Preterm Infants: Role of Neonatal Characteristics and Nutrition in Achieving Growth Similar to Term Infants

Neonatology ◽

10.1159/000450882 ◽

2016 ◽

Vol 111 (3) ◽

pp. 214-221 ◽

Cited By ~ 10

Author(s):

Geneviève Tremblay ◽

Christine Boudreau ◽

Sylvie Bélanger ◽

Odette St-Onge ◽

Etienne Pronovost ◽

...

Keyword(s):

Body Composition ◽

Preterm Infants ◽

Term Infants ◽

Very Preterm Infants ◽

Very Preterm

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Choline Content of Term and Preterm Infant Formulae Compared to Expressed Breast Milk—How Do We Justify the Discrepancies?

Nutrients ◽

10.3390/nu12123815 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3815

Author(s):

Anna Shunova ◽

Katrin A. Böckmann ◽

Michaela Minarski ◽

Axel R. Franz ◽

Cornelia Wiechers ◽

...

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Plasma Concentrations ◽

Third Trimester ◽

Term Infants ◽

Fetal Plasma ◽

Infant Formulae ◽

Expressed Breast Milk ◽

Free Choline ◽

Choline Intake

Choline/phosphatidylcholine concentrations are tightly regulated in all organs and secretions. During rapid organ growth in the third trimester, choline requirement is particularly high. Adequate choline intake is 17–18 mg/kg/day in term infants, whereas ~50–60 mg/kg/day is required to achieve fetal plasma concentrations in preterm infants. Whereas free choline is supplied via the placenta, other choline carriers characterize enteral feeding. We therefore quantified the concentrations and types of choline carriers and choline-related components in various infant formulae and fortifiers compared to breast milk, and calculated the supply at full feeds (150 mL/kg/day) using tandem mass spectrometry. Choline concentration in formula ranged from values below to far above that of breastmilk. Humana 0-VLB (2015: 60.7 mg/150 mL; 2020: 27.3 mg/150 mL), Aptamil-Prematil (2020: 34.7 mg/150 mL), Aptamil-Prematil HA (2020: 37.6 mg/150 mL) for preterm infants with weights < 1800 g, and Humana 0 (2020: 41.6 mg/150 mL) for those > 1800 g, comprised the highest values in formulae studied. Formulae mostly were rich in free choline or phosphatidylcholine rather than glycerophosphocholine and phosphocholine (predominating in human milk). Most formulae (150 mL/kg/day) do not supply the amounts and physiologic components of choline required to achieve fetal plasma choline concentrations. A revision of choline content in formulae and breast milk fortifiers and a clear declaration of the choline components in formulae is required to enable informed choices.

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The Revolution of Breast Milk: The Multiple Role of Human Milk Banking between Evidence and Experience—A Narrative Review

International Journal of Pediatrics ◽

10.1155/2021/6682516 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Pasqua Anna Quitadamo ◽

Giuseppina Palumbo ◽

Liliana Cianti ◽

Paola Lurdo ◽

Maria Assunta Gentile ◽

...

Keyword(s):

Breast Milk ◽

Human Milk ◽

Preterm Infants ◽

Multiple Role ◽

Life Saving ◽

The World ◽

Human Milk Banking ◽

Milk Banking ◽

Main Component

The review recalls the importance of breast milk and deepens the theme of human milk banking, a virtuous reality that is expanding all over the world but is still little known. In the last 15 years, modern biological technologies have crystallized the concept of uniqueness and irreproducibility of human milk, by establishing three new principles: first: human milk: a “life-saving” drug; second: human milk: the best food for preterm infants; and third: human milk: the main component of premature infant care. Our experience teaches us that human milk banking plays many roles that need to be known and shared.

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Comprehensive Preterm Breast Milk Metabotype Associated with Optimal Infant Early Growth Pattern

Nutrients ◽

10.3390/nu11030528 ◽

2019 ◽

Vol 11 (3) ◽

pp. 528 ◽

Cited By ~ 10

Author(s):

Marie-Cécile Alexandre-Gouabau ◽

Thomas Moyon ◽

Agnès David-Sochard ◽

François Fenaille ◽

Sophie Cholet ◽

...

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Growth Pattern ◽

Critical Role ◽

Holistic Approach ◽

Early Growth ◽

Energy Utilization ◽

Study Population ◽

Branched Chain

Early nutrition impacts preterm infant early growth rate and brain development but can have long lasting effects as well. Although human milk is the gold standard for feeding new born full-term and preterm infants, little is known about the effects of its bioactive compounds on breastfed preterm infants’ growth outcomes. This study aims to determine whether breast milk metabolome, glycome, lipidome, and free-amino acids profiles analyzed by liquid chromatography-mass spectrometry had any impact on the early growth pattern of preterm infants. The study population consisted of the top tercile-Z score change in their weight between birth and hospital discharge (“faster grow”, n = 11) and lowest tercile (“slower grow”, n = 15) from a cohort of 138 premature infants (27–34 weeks gestation). This holistic approach combined with stringent clustering or classification statistical methods aims to discriminate groups of milks phenotype and identify specific metabolites associated with early growth of preterm infants. Their predictive reliability as biomarkers of infant growth was assessed using multiple linear regression and taking into account confounding clinical factors. Breast-milk associated with fast growth contained more branched-chain and insulino-trophic amino acid, lacto-N-fucopentaose, choline, and hydroxybutyrate, pointing to the critical role of energy utilization, protein synthesis, oxidative status, and gut epithelial cell maturity in prematurity.

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Antioxidant Capacity of Breast Milk of Mothers who Delivered Prematurely is Higher Than That of Mothers who Delivered at Term

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000082 ◽

2011 ◽

Vol 81 (6) ◽

pp. 368-371 ◽

Cited By ~ 8

Author(s):

H. Turhan ◽

Atıcı ◽

Muslu

Keyword(s):

Oxidative Stress ◽

Breast Milk ◽

Antioxidant Capacity ◽

Preterm Infants ◽

Total Antioxidant Capacity ◽

Neonatal Period ◽

Term Infants ◽

Milk Samples ◽

Total Antioxidant ◽

The Mean

Background: The total antioxidant capacity of plasma of preterm infants has been suggested to be lower than that of term infants. The objective of this study was to compare the total antioxidant capacity of the breast milk of mothers who delivered prematurely with that of mothers who delivered at term. Materials and Methods: A total of 71 breast milk samples were collected, 41 from mothers who delivered preterm (27 to 37 weeks) and 30 from mothers who delivered at term (38 to 42 weeks). Results: The mean total antioxidant capacity of the breast milk of mothers who delivered prematurely was higher (2.19 ± 0.88 mmol/L) than that of mothers who delivered at term (1.7 ± 0.86 mmol/L) (p = 0.024). Conclusion: Breastfeeding may protect preterm infants against oxidative stress and related disorders in the neonatal period.

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Committee Report Needs Clarification

PEDIATRICS ◽

10.1542/peds.61.1.153 ◽

1978 ◽

Vol 61 (1) ◽

pp. 153-153

Author(s):

H. L. Kafka

Keyword(s):

Breast Milk ◽

Iron Deficiency ◽

Preterm Infants ◽

Iron Supplementation ◽

Point Of View ◽

Committee Report ◽

Term Infants ◽

Breast Feed ◽

Fortified Cereal ◽

Breast Fed

McMillan et al. in their article "Iron Sufficiency in Breast-Fed Infants and the Availability of Iron From Human Milk" (Pediatrics 58:686, November 1976) made it clear that iron from breast milk is better absorbed than iron from any other source, and that it is therefore safe, at least from the point of view of iron deficiency, to breast feed an infant up to 18 months of age. In the same issue (p. 765) the Committee on Nutrition recommends that "iron supplementation from one or more sources should start no later than 4 months of age in term infants and no later than 2 months of age in preterm infants . . ." and a few lines later that ". . . In breast-fed infants the best source [of iron] is iron-fortified cereal, two portions per day. . . ." Yet the Committee states that "the needs of breast-fed infants for supplemental iron require more investigation."

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