Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants.

Katherine Marie Ottolini,Catherine Limperopoulos,Elizabeth Vinson Schulz,Nickie Andescavage

doi:10.3390/nu13124307

Abstract

Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.

Highlights

The third trimester of pregnancy represents a period of rapid fetal growth resulting from increased placental nutrient and energy transfer
In comparison to the developing fetus, preterm infants born during this critical developmental window are exposed to unique environmental stressors and systemic illness within the extrauterine environment that pose additional nutritional demands to achieve growth rates that parallel in utero nutrient accretion [2]
Despite advances in neonatal nutrition, half of all very low birth weight (VLBW,

Summary

Introduction

The third trimester of pregnancy represents a period of rapid fetal growth resulting from increased placental nutrient and energy transfer. The rate of fetal protein accretion during the second half of pregnancy is estimated to be approximately 2 g/kg/day [1,2]. Fat accretion occurs almost entirely after 25 weeks’ gestation, increasing exponentially thereafter and peaking at 7 g/day by term [3]. Adequate nutrient transfer during this timeframe is essential for the developing human brain, with cerebral and cerebellar volumes increasing by 230% and 384%, respectively, between 25- and 37-weeks’. In comparison to the developing fetus, preterm infants born during this critical developmental window are exposed to unique environmental stressors and systemic illness within the extrauterine environment that pose additional nutritional demands to achieve growth rates that parallel in utero nutrient accretion [2]. Postnatal growth has major implications for preterm brain development, as

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