BALTIMORE – For a premature infant, breast milk straight from Mom or a donor may not be the ideal meal.
The problem is that breast milk is often unbalanced in its content of protein, fat, and carbohydrates, and for a premature neonate fed by a nasogastric tube, unfortified breast milk can provide too little of one nutrient or too much of another. Conventional fortification of breast milk adds a standardized cocktail of nutrients that doesn’t provide an ideal balance for optimal growth.
Frequent analysis of breast milk’s nutrient content and target fortification to tweak the milk to a more ideal nutrient balance may be a way around this problem, and results from a single-center, randomized trial with 85 premature infants showed that this approach led to significantly better infant weights when measured at 36 weeks postmenstrual age, Dr. Christoph Fusch reported at the annual meeting of the Pediatric Academic Societies.
Mitchel L. Zoler/Frontline Medical News
Dr. Christoph Fusch
Target fortification of breast milk resulted in an average weight at 36 weeks postmenstrual age of 2,510 g among 42 infants in the intervention group, compared with an average weight of 2,280 g among 43 control infants who received breast milk that underwent routine fortification with a commercial product – a statistically significant difference for the study’s primary endpoint, said Dr. Fusch, professor of pediatrics at McMaster University and director of the neonatal intensive care unit at McMaster Children’s Hospital, both in Hamilton, Ont.
Baseline weights in the two groups of premature infants, who were born at an average of 27 weeks’ gestation and began the study at an average age of about 30 weeks’ postmenstrual age, were 970 g in the controls and 960 g in the infants who received target fortification.
The benefit from target fortification was even more dramatic in the 50% of infants fed on breast milk with the lowest protein content. In this subgroup, the 21 infants on target fortification weighed an average of 2,540 g at 36 weeks postmenstrual age, compared with an average weight of 2,170 g among 21 control infants.
“If you use standard fortification you never get [the nutrients] right. Too many nutrients will be outside [the ideal range] and those babies have a high risk of not growing,” Dr. Fusch noted in an interview.
One of the key steps in the study was measuring the protein, fat, and carbohydrate content of the breast milk that each infant received 3 days a week and using those data to guide fortification. Assessment of each breast milk specimen takes about 2 minutes, after which a technician adds the required levels of freshly prepared nutrient supplements to produce a final protein content of 3 g/dL, fat at 4.3 g/dL, and carbohydrate at 8.5 g/dL. The researchers set these levels based on an assumed daily intake of 150 mL/kg of fortified breast milk.
Dr. Fusch and his associates plan additional analyses of the data they collected in this study to look at the impact of target fortification on infant length and head circumference, metabolic responses, body composition, and neurodevelopment out to 18 months of age. They also have launched a larger, multicenter study with a similar design at 10 sites in Europe and 8 sites in North America.
The infants who stand to gain the most from target fortification are those fed donor breast milk, an increasingly popular option when breast milk from the infant’s mother is not available, but also a flawed option because this milk is usually low in protein, said Dr. Fusch, who also holds the Jack Sinclair Chair in Neonatology at the university. Target fortification is not an issue for term infants who feed normally because they usually cry to demand more milk when they lack specific nutrients. Premature infants are much more vulnerable when fed by a nasogastric tube because they will become sated simply by milk volume and then stop eating, even when they ingest an unbalanced nutrient supply.