Is mother's milk the most suitable food for very low birth weight infants?

Human milk feeding (HMF) as compared with formula feeding (FF) has the advantage of more effective utilization of proteins, fat, minerals and trace elements. HMF provides passive immunologic protection and active immunostimulation. It prevents the VLBWI from antigenic and toxic loads. The disadvantage of HMF is the high volume required tomeet the energy and protein needs of the VLBWI and the growing potential risk of AIDS, hepatitis and cytomegaly infections which makes human milk banking increasingly difficult. The current concept of VLBWI formula feeding (FF) is based on high protein, energy and mineral concentrations to compensate for the lower biological value, for lower bioavailability and for side effects related to the antigenicity of food proteins. FF as compared with HMF results is increased mineral and water retention, in high renal load and in a completely different body composition. The risk of necrotizing enteritis is significantly higher. All this has to be considered a challenge to further adapt LBWI formulas to the amino acid composition of human milk protein to induce bifidogenic effects and to provide sufficient amounts of essential fatty acids and carbohydrates which serve as building stones for normal brain development.