Abstract
Breast milk does not meet the nutritional needs of preterm infants, necessitating fortification. Breast milk is particularly variable in protein content, hence standardized (fixed dosage) supplementation results in inadequate supply. This was a secondary analysis of 589 breast milk protein content measurements of 51 mothers determined by mid-infrared spectroscopy during a clinical trial of higher versus lower protein supplementation in very low birth weight infants. Mothers (and breast milk samples) were divided into a test (41 mothers) and a validation cohort (10 mothers). In the test cohort, the decrease in protein content by day of lactation was modeled resulting in the breast milk-equation (BME)). In the validation cohort, five supplementation strategies to optimize protein supply were compared: standardized supplementation (adding 1.0 g (S1) or 1.42 g protein/100 mL (S2)) was compared with ‘adapted’ supplementation, considering variation in protein content (protein content according to Gidrewicz and Fenton (A1), to BME (A2) and to BME with adjustments at days 12 and 26 (A3)). S1 and S2 achieved 5% and 24% of adequate protein supply, while the corresponding values for A1–A3 were 89%, 96% and 95%. Adapted protein supplementation based on calculated breast milk protein content is easy, non-invasive, inexpensive and improves protein supply compared to standardized supplementation.
Highlights
Breast milk feeding is the recommended feeding for all newborn infants including those born preterm [1]
We present a practical strategy for optimizing protein intake without the need for blood sampling or breast milk measurements, and compared this with standardized protein supplementation based on the breast milk protein content of 598 breast milk samples from 51 mothers obtained during the underlying clinical trial
From October 2012 to October 2014, 60 predominantly breast milk-fed very low birth weight infants were included and no significant difference in growth velocity from birth to end of intervention between different levels of protein supply was shown [18]
Summary
Breast milk feeding is the recommended feeding for all newborn infants including those born preterm [1]. Individual supplementation (adjustable or targeted) results in better protein supply and promotes growth in very preterm infants [14,15,16,17] and involves additional burden to the children (blood sampling), workload and costs. The aim of this secondary analysis of the breast milk samples analyzed in a previous randomized controlled trial (RCT) was to establish a feasible supplementation strategy for everyday practice in neonatal units. We present a practical strategy for optimizing protein intake without the need for blood sampling or breast milk measurements, and compared this with standardized protein supplementation based on the breast milk protein content of 598 breast milk samples from 51 mothers obtained during the underlying clinical trial
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