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Macromineral balances in premature infants fed their own mothers' milk or formula
Insights
Mother's milk provided sufficient sodium, potassium, and chloride for very low birth weight (VLBW) infants. However, neither maternal milk nor formula adequately supplied calcium and phosphorus for optimal VLBW infant growth.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Infant Development
Background:
- Very low birth weight (VLBW) infants have unique nutritional needs.
- Optimizing nutrient intake is crucial for VLBW infant growth and development.
- Comparing maternal milk and specialized formulas is essential for VLBW infant care.
Purpose of the Study:
- To compare the retention of key minerals (sodium, potassium, magnesium, calcium, phosphorus) in VLBW infants fed either mother's milk or modified infant formula.
- To assess if nutrient retention aligns with intrauterine accretion rates for VLBW infants.
- To inform optimal feeding strategies for VLBW infants.
Main Methods:
- Paired groups of seven VLBW infants (birth weight < 1.3 kg) were studied.
- Infants were fed either their mother's own milk or a modified infant formula (SMA).
- Mineral status (sodium, potassium, magnesium, calcium, phosphorus) was monitored during the first postnatal month.
Main Results:
- Mother's milk led to higher sodium retention than standard formula in the first two weeks.
- Formula supplementation with sodium bicarbonate improved sodium retention in VLBW infants after two weeks.
- Potassium retention was similar to intrauterine rates in both groups.
- Magnesium, calcium, and phosphorus intake were higher with formula, but retention did not meet intrauterine rates for either feeding group.
- Hypophosphatemia occurred in infants receiving mother's milk.
- Linear and head circumference growth approximated intrauterine rates for both groups.
Conclusions:
- Early maternal milk supports adequate retention of sodium, chloride, and potassium in VLBW infants.
- Neither human preterm milk nor the studied formula provided sufficient calcium and phosphorus for VLBW infants.
- Nutrient requirements for VLBW infants should be based on intrauterine accretion rates to ensure optimal growth and development.
Abstract:
The premature infant's own mother's milk (preterm milk) and modified infant formula (SMA, 67 and 80 kcal/dl) were fed to paired groups of seven infants, all of whom were of very low birth weight (VLBW) (less than 1.3 kg) and were studied during the first month of life. Sodium, potassium, magnesium, calcium, and phosphorus status was compared. The apparent retention of sodium from their mother's milk paralleled intrauterine retention rates and was greater than retention from SMA formula (P less than 0.01) during the first two weeks of life. However, when the formula was supplemented with NaHCO3 to intakes of 2.7 mmol Na/kg/24 hr after week 2, the infants retained adequate amounts of sodium. Potassium retention was similar to intrauterine retention rates in both groups throughout the four postnatal weeks. Magnesium intake, but not retention, was consistently higher in the group fed SMA (P less than 0.01), and intrauterine retention rates were achieved only in the group given formula. Calcium and phosphorus intakes from SMA were also higher (P less than 0.01) than from human milk. However, retention of calcium and phosphorus in both groups did not meet intrauterine retention rates, and hypophosphatemia developed in infants who received their mothers' milk. Growth in length and head circumference in both groups approximated intrauterine growth rates. If it is assumed that body composition of the growing VLBW infants should be similar to the composition of the fetus at corresponding gestational ages, then their nutrient requirements should be based on knowledge of intrauterine nutrient accretion rates. Based on this premise, we conclude that, for the growing VLBW infant, early maternal milk provided for sufficient retention of sodium, chloride, and potassium during the first four postnatal weeks. Neither human preterm milk nor SMA supplied adequate calcium and phosphorus for the growing VLBW infant.