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Nutrient balance, metabolic response, and bone growth in VLBW infants fed fortified human milk
T Hayashi1, T Takeuchi, K Itabashi
1Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
Insights
Fortifying preterm human milk with protein and minerals significantly improved nitrogen retention and bone density in very low birth weight infants. This supplementation addresses nutritional gaps in preterm human milk.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Human Milk Fortification
Background:
- Preterm infants, especially those with very low birth weight, have unique nutritional needs.
- Standard preterm human milk may lack sufficient protein and minerals for optimal growth and development.
- Nutritional inadequacies can lead to impaired growth and metabolic complications in vulnerable neonates.
Purpose of the Study:
- To evaluate the impact of fortifying preterm human milk with a protein-mineral supplement.
- To compare nitrogen and energy balance in infants receiving fortified versus unfortified human milk.
- To assess the effects on biochemical markers, bone density, and overall growth in very low birth weight infants.
Main Methods:
- A comparative study involving two groups of very low birth weight infants (gestational age ≤ 30 weeks).
- Group 1 received fortified preterm human milk (protein, calcium, phosphorus supplement).
- Group 2 received unfortified preterm human milk; nitrogen/energy balance, serum markers, and bone density were assessed.
Main Results:
- Significantly higher nitrogen retention (348.2 mg/kg/day) in the fortified group compared to the unfortified group (196.0 mg/kg/day).
- Improved serum protein, albumin, and mineral status (calcium, phosphorus) in fortified infants by 8 weeks.
- Greater bone density and width of the distal third radius in the fortified group by 12 weeks post-birth.
Conclusions:
- Supplementation of preterm human milk with a protein-mineral blend effectively enhances nitrogen retention.
- Fortification leads to improved biochemical and bone mineralization status in very low birth weight infants.
- The studied supplement appears to correct nutritional deficiencies in preterm human milk for this vulnerable population.
Abstract:
The effects of fortification of preterm human milk were evaluated by comparing two groups of very low birth weight infants (birth weight < or = 1300 g, gestational age < or = 30 weeks): six fed preterm human milk fortified with a commercially available protein-mineral supplement (protein 0.7 g/dl, calcium 90 mg/dl, phosphorus 45 mg/dl) and seven fed unfortified preterm human milk. Nitrogen and energy balance studies were performed at an average age of 56 postnatal days. Nitrogen retention in the fortified group (348.2 +/- 70.5 mg/kg/day) was significantly greater than that in the unfortified group (196.0 +/- 50.0 mg/kg/day) and similar to that of fetuses of comparable gestational age. Energy stored by the two groups did not differ. At age 8 weeks, the infants in the fortified group had higher serum protein, higher serum albumin, and better mineral status (higher serum calcium and phosphorus and lower alkaline phosphatase and renal tubular reabsorption of phosphate). The bone density and width of the distal third radius, as measured by X-ray microdensitometry, were greater in the fortified group than in the unfortified group 12 weeks after birth. These results suggest that the supplement corrects any nutritional inadequacies of preterm human milk for very low birth weight infants.