Abstract
The influence of types of human milk (HM)—raw own mother’s milk (OMM), pasteurized OMM, and donor milk (DM)—was evaluated for growth in premature infants fed exclusively HM with controlled nutritional intakes using daily individualized HM fortification (IHMF). Growth and nutritional intakes were prospectively collected in preterm infants (<32 weeks) fed IHMF and compared in infants fed predominantly (≥75%) OMM and DM. The influence of HM types (raw OMM, pasteurized OMM, and DM) on growth were also evaluated in the whole population. One-hundred and one preterm infants (birth weight 970 ± 255 g, gestational age 27.8 ± 1.9 weeks) were included. Energy (143 ± 8 vs. 141 ± 6 kcal/kg/day; p = 0.15) and protein intakes (4.17 ± 0.15 vs. 4.15 ± 0.14 g/kg/day; p = 0.51) were similar in both groups. Infants receiving predominantly OMM (n = 37), gained significantly more weight (19.8 ± 2.0 vs. 18.2 ± 2.2 g/kg/day; p = 0.002) and length (1.17 ± 0.26 vs. 0.99 ± 0.36 cm/week; p = 0.020) than those fed predominantly DM (n = 33). Stepwise multivariate analysis (n = 101) suggests that raw OMM was the major determinant of growth, contributing 22.7% of weight gain. Length gain was also related to OMM (raw + pasteurized) intakes, explaining 4.0% of length gain. In conclusion, at daily controlled similar protein and energy intakes, OMM had significant beneficial effects on weight and length versus DM in VLBW infants. This difference could be partially explained by the use of raw OMM.
Highlights
In premature infants, human milk (HM) is associated with significant benefits on health and development
We found that raw > pasteurized OMM (ROMM) and pasteurized > raw OMM (POMM) both have a positive effect on weight gain, contributing to an increase of +2.8 g/kg/day and +0.9 g/kg/day, respectively, compared to donor milk (DM)
Our study suggests that the use of raw own mother’s milk (OMM) induces a significant positive effect on weight (p = 0.003), length (p = 0.013), and head circumference (HC) (p = 0.016) Z-score gains during the study period compared to DM
Summary
Human milk (HM) is associated with significant benefits on health and development. The mother’s own milk (OMM) is always recommended as the first nutritional choice. When OMM is unavailable, the use of donor milk (DM) rather than formula could be the first alternative for very low birth weight (VLBW) infants of less than 32 weeks [1,2,3]. OMM or banked DM, will not provide intakes that reach current nutritional recommendations. Fortification is recommended to improve post-natal growth [7,8]. That remains a concern as postnatal nutritional deficit and growth restriction during the neonatal period could be linked to altered long term health and neurodevelopment outcomes [12,13,14]
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