[Human milk and very low birth weight nutrition]

Enteral feeding strategies of very low birth weight (VLBW) infants and when to start them have changed significantly in the last few years. Controversy exists on which is the best regimen to feed this high risk group, since human milk has insufficient quantities of some nutrients. Fortification of human milk improves growth rates and maintains immunologic, metabolic and emotional benefits.

To examine if early feeding of VLBW infants with higher amounts of human milk and human milk fortifiers could improve post-natal growth and maintain human milk production.

Prospective study with historical control.

A group of 100 VLBW infants that were born between September 1999 and April 2000 were studied and were compared with another randomized group of similar birth weight (n = 31) that was born previously. The studied group was fed early with human milk (enteral trophic nutrition) and fortified with human milk fortifier when 100 mL/Kg/day were reached, with rapid increase of the supplies according to tolerance and hemodynamic state. The control group was not fed early with human milk and was not given human milk fortifier. The collection of human milk in the studied group was highly stimulated. Mothers extracted their milk more frequently in the "Human Milk Lactary" and lived in a "Residence for Mothers" while their neonates were in the hospital. The mothers who could travel to the hospital were allowed to extract their milk in their homes with a supervised and controlled method (serial bacteriology, "Lactary 24 Hours Program").

Early feeding with human milk (enteral trophic nutrition), higher amounts of human milk and fortified with human milk fortifier, improved enteral tolerance and diminished significantly the number of days needed to regain birth weight, the days of fast and the days to reach the total enteral supply. Frequent extractions of human milk increased the available amounts of milk and allowed relactation. At discharge the infants were fed on breast-milk and formulas and their growth curves were adequate at their first year of post conception age.

On stable conditions, very low birth infants soon after birth, should be fed with a combination of human milk and human milk fortifiers. Our study demonstrated an improved infant post-natal growth while mothers' milk production was maintained.

To feed human milk with human milk fortifiers to this high risk infant group, the neonatal health team must be highly motivated and committed to encourage mothers to express their milk. This also encourages breast feeding during the subsequent months. In Latin America communities, continuance of breast feeding for longer periods of time is a public health priority.