Abstract
Target fortification (TFO) reduces natural macronutrient variation in breast milk (BM). Daily BM analysis for TFO increases neonatal intensive care unit work load by 10–15 min/patient/day and may not be feasible in all nurseries. The variation of macronutrient intake when BM analysis is done for various schedules was studied. In an observational study, we analyzed 21 subsequent samples of native 24-h BM batches, which had been prepared for 10 healthy infants (gestational age 26.1 ± 1.3 weeks, birth weight: 890 ± 210 g). Levels of protein and fat (validated near-infrared milk analyzer), as well as lactose (UPLC-MS/MS) generated the database for modelling TFO to meet recommendations of European Society for Paediatric Gastroenterology Hepatology and Nutrition. Intake of macronutrients and energy were calculated for different schedules of BM measurements for TFO (n = 1/week; n = 2/week; n = 3/week; n = 5/week; n = 7/week) and compared to native and fixed dose fortified BM. Day-to-day variation of macronutrients (protein 20%, carbohydrate 13%, fat 17%, energy 10%) decreased as the frequency of milk analysis increased and was almost zero for protein and carbohydrate with daily measurements. Measurements two/week led to mean macronutrient intake within a range of ±5% of targeted levels. A reduced schedule for macronutrient measurement may increase the practical use of TFO. To what extent the day-to-day variation affects growth while mean intake is stable needs to be studied.
Highlights
Breast milk is recommended as the first choice of nutrition for very low birth weight (VLBW, birth weight
We investigated the variation of fat, protein, carbohydrate and energy of pooled native breast milk, fixed dose fortified breast milk and target fortified breast milk when fortification was based on different schedules of macronutrient measurements
The main findings of the study were: (1) fixed dose fortification of breast milk was not sufficient to provide macronutrients at the recommended level in all preterm infants; (2) target fortification with daily measurements precisely achieved recommended target intake; (3) the reduction of measurement frequency increased the day-to-day variation; (4) measurements twice a week assured that, on average, no infant received an intake that was below the recommended targets; and (5) the higher amount of carbohydrates and fat in some of the batches was due to the composition of native breast and/or fixed dose fortifier, but not an effect of target fortification
Summary
Breast milk is recommended as the first choice of nutrition for very low birth weight (VLBW, birth weight
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