Enhanced fortification of human milk to meet preterm infant nutritional targets

Many preterm infants need nutrition beyond 24 kcal/oz (standard fortification) to support growth. Individualized targeted fortification improves growth but is labor-intensive. Universal enhanced fortification to presumed 26 kcal/oz for very low birth weight infants was clinically implemented. We determined how often donor breast milk (DBM) and preterm maternal breast milk (MBM) met nutritional targets with enhanced fortification.

MBM/DBM samples were collected for a prospective cohort study of infants born <1500 g and <33 weeks. Macronutrients were measured using a mid-infrared analyzer. The frequency at which MBM/DBM samples met intake goals (4.8-8.1 g/kg/day fat, 11.6-13.2 g/kg/day carbohydrate, 3.5-4.5 g/kg/day protein) with enhanced and standard fortification was compared.

Among 198 MBM samples and 168 DBM samples, MBM had higher protein, fat, and energy (p < 0.0001). Regardless of fortification method, MBM samples met lower and mid-range fat goals more often (p < 0.01 and p = 0.03, respectively). Collectively, more samples achieved protein targets with enhanced fortification: all samples reached 3.5 and 4 g/kg/day, 56% (147 MBM, 58 DBM) attained 4.5 g/kg/day. With standard fortification, 11% achieved 4 g/kg/day protein; none attained 4.5 g/kg/day.

Enhanced fortification is an efficient method that meets enteral nutrition goals for preterm infants and delivers desired protein intake more consistently.

Enhanced fortification is a feasible and efficient alternative to targeted fortification that can also achieve enteral nutrition goals for preterm infants. Enhanced fortification delivers desired protein intake more consistently than standard fortification, especially with donor breast milk. Regardless of fortification strategy, maternal breast milk is more likely to reach fat intake goals, although additional enrichment may be needed, depending on the fortifier product.