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Challenges in breast milk fortification for preterm infants
Niels Rochow1, Erin Landau-Crangle, Christoph Fusch
1Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Current Opinion in Clinical Nutrition and Metabolic Care
|March 26, 2015
Summary
New fortification methods for preterm infant feeding optimize nutrient intake. Target fortification shows promise, but analyzers need improvement, and safety cutoffs for breast milk fortification are still unclear.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
- Human milk research
Background:
- Breast milk is crucial for preterm infants due to immunoprotective properties.
- Standard breast milk fortification is challenged by high interindividual nutrient variation.
- Optimizing preterm infant nutrition requires addressing breast milk composition variability.
Purpose of the Study:
- To review recent evidence (2013-2014) on breast milk fortification for preterm infants.
- To explore novel fortification strategies and their impact on growth and development.
- To assess the feasibility and limitations of current fortification technologies.
Main Methods:
- Review of scientific literature published between 2013 and 2014.
- Analysis of new fortification strategies: adjustable and target fortification.
- Evaluation of breast milk analyzer precision for nutrient analysis.
Main Results:
- Adjustable and target fortification strategies improve macronutrient intake and growth in preterm infants.
- Target fortification is feasible in clinical settings, but current analyzers lack precision for lactose and energy.
- Exclusively human milk diets may reduce feeding intolerance and necrotizing enterocolitis.
- Evidence for postdischarge breast milk fortification benefits is limited.
- The role of nutrient composition and structure in infant development is an emerging area.
Conclusions:
- Research highlights breast milk variability, its effect on growth, and the potential of target fortification.
- Exclusive human milk diets offer a promising approach for improved feeding tolerance.
- Further research is needed to establish safety osmolality cutoff levels for fortification.
- Developing precise breast milk analyzers is crucial for effective target fortification.
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