Protein Enrichment of Donor Breast Milk and Impact on Growth in Very Low Birth Weight Infants.

Trayce Fields,Alonzo T Folger,Heather C Kaplan,Katelyn Gordon,Ting Ting Fu,Brenda B Poindexter

doi:10.3390/nu13082869

Abstract

Protein content is often inadequate in donor breast milk (DBM), resulting in poor growth. The use of protein-enriched target-pooled DBM (DBM+) has not been examined. We compared three cohorts of very low birth weight (VLBW) infants, born ≤ 1500 g: DBM cohort receiving > 1-week target-pooled DBM (20 kcal/oz), MBM cohort receiving ≤ 1-week DBM, and DBM+ cohort receiving > 1-week DBM+. Infants followed a standardized feeding regimen with additional fortification per clinical discretion. Growth velocities and z-scores were calculated for the first 4 weeks (n = 69 for DBM, 71 for MBM, 70 for DBM+) and at 36 weeks post-menstrual age (n = 58, 64, 59, respectively). In total, 60.8% MBM infants received fortification >24 kcal/oz in the first 30 days vs. 78.3% DBM and 77.1% DBM+. Adjusting for SGA, length velocity was greater with DBM+ than DBM in week 1. Average weight velocity and z-score change were improved with MBM compared to DBM and DBM+, but length z-score decreased similarly across all groups. Incidences of NEC and feeding intolerance were unchanged between eras. Thus, baseline protein enrichment appears safe in stable VLBW infants. Weight gain is greatest with MBM. Linear growth comparable to MBM is achievable with DBM+, though the overall length trajectory remains suboptimal.

Highlights

Donor breast milk (DBM) is recommended as an alternative to preterm formula for supplementing maternal breast milk (MBM) in very low birth weight (VLBW) infants, but nutritional concerns remain [1]
While early protein intake and linear growth have both been associated with neurodevelopmental outcomes [5,6,7], enteral provision of protein via human milk is typically limited by baseline protein content, which is notably lower in DBM compared to MBM
gestational age (GA) was similar in all three groups, the DBM cohort had a lower mean birth weight and a greater proportion of Small for gestational age (SGA) infants compared to DBM+ (p = 0.04 and 0.05)

Summary

Introduction

Donor breast milk (DBM) is recommended as an alternative to preterm formula for supplementing maternal breast milk (MBM) in very low birth weight (VLBW) infants, but nutritional concerns remain [1]. Some human milk banks utilize target-pooling to combine milk of multiple donors strategically, rather than randomly, to reduce nutritional variability and potentially increase nutritional content, commonly attempting to achieve a minimum caloric density of 20 kcal/oz (67 kcal/dL) [2]. Even with this technique, protein concentration is often inadequate [3,4]. This early enteral protein deficit is compounded by the time required to reaching a feeding volume at which multicomponent fortification can occur

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