Human Milk Group Research Articles

Effects of Increased Calcium and Phosphorous Formulas and Human Milk on Bone Mineralization in Preterm Infants

Summary: By photon absorptiometry, extrauterine bone mineralization was evaluated in preterm infants (< 1,600 g birth weight) fed either (a) a commercial premature formula containing 117 mg calcium, 58.5 mg phosphorus/100 kcal, (b) the same formula containing higher phosphorus (82 mg/100 kcal), (c) the same formula with higher calcium (140 mg Ca) and phosphorus (82 mg/100 kcal), or (d) their own mother's milk. All infants had serum protein, albumin, calcium, phosphorus, bicarbonate, 25‐hydroxy‐vitamin D, and alkaline phosphatase levels done at the start of the study and every 2 weeks until they weighed 1,900 g. At the start of the study, birth weight and gestational ages were similar in all four groups. There were no biochemical differences among the four groups except for a lower serum P in the human milk group. The human milk group had lower bone mineralization rate compared with the three formula groups. Bone mineral content was similar in the three formula‐fed groups. However, only formulas containing 117 mg Ca and 58.5 mg P or 140 mg Ca and 82 P mg/100 kcal approximated intrauterine bone mineralization. Human milk fed infants did not approximate and were significantly different from the intrauterine rate.

Effects of increased calcium and phosphorous formulas and human milk on bone mineralization in preterm infants.

By photon absorptiometry, extrauterine bone mineralization was evaluated in preterm infants (less than 1,600 g birth weight) fed either a commercial premature formula containing 117 mg calcium, 58.5 mg phosphorus/100 kcal, the same formula containing higher phosphorus (82 mg/100 kcal), the same formula with higher calcium (140 mg Ca) and phosphorus (82 mg/100 kcal), or their own mother's milk. All infants had serum protein, albumin, calcium, phosphorus, bicarbonate, 25-hydroxyvitamin D, and alkaline phosphatase levels done at the start of the study and every 2 weeks until they weighed 1,900 g. At the start of the study, birth weight and gestational ages were similar in all four groups. There were no biochemical differences among the four groups except for a lower serum P in the human milk group. The human milk group had lower bone mineralization rate compared with the three formula groups. Bone mineral content was similar in the three formula-fed groups. However, only formulas containing 117 mg Ca and 58.5 mg P or 140 mg Ca and 82 P mg/100 kcal approximated intrauterine bone mineralization. Human milk fed infants did not approximate and were significantly different from the intrauterine rate.

Nitrogen and Mineral Balance in Preterm Infants Fed Human Milks or Formula

Growth as well as nitrogen, calcium, sodium, and potassium balances were evaluated in 16 preterm infants weighing less than 1,600 g at birth, who were fed either their mother's milk, donated mature human milk, or standard commercial formula. Birthweight, gestational age, age of balance, and energy and fluid intakes were similar between groups. There were no differences between groups in the rate of growth. The infants fed their mother's milk (obtained 11–30 days into lactation) demonstrated nutrient balance similar to infants fed mature human milk. Infants fed standard commercial formula demonstrated significantly greater intake and retention of calcium compared to either human milk group. Infants fed either their mother's milk or mature human milk demonstrated net nitrogen and calcium retention below estimates of fetal nitrogen and calcium accretion. Infants fed standard formula demonstrated retentions that more closely approach the fetal estimates. This study did not demonstrate an advantage to feeding premature infants their mother's milk when compared to the feeding of mature donor milk.

528 BONE MINERALIZATION IN BREAST-FED PREMATURE INFANTS

Based on the calcium (Ca) and phosphate (P) requirements of premature infants, human milk (HM) may not provide for optimal bone mineralization. To determine the adequacy of HM in nursing premature infants we studied 11 breast-fed and 9 SimilacR (SIM) fed infants during the first 16 weeks of life. There were no differences between both groups in gestational age (33.7±0.5 (M±SE) for HM vs. 32.2±0.8 wks for SIM) or birth weight (1.98±.14 vs. 1.77±.16 kg). At 4-8 wks and 12-16 wks of age, bone mineral content (BMC) was measured by direct photon absorptiometry of the left wrist and blood drawn for serum total Ca, P, alkaline phosphatase (AP) and 25-hydroxyvitamin D (25-OH D) levels. At 4-8 wks, there were no differences between the HM or SIM groups in BMC (X, 65 vs. 58 mg/cm), P (X, 7.3 vs. 8.3 mg/dl), AP (X, 163 vs. 156 IU/L; normal children 47-112 IU/L), 25-OH D (X, 16 vs. 20 ng/m1; adult normal 10-40 ng/m1) or weight (X, 2.60 vs. 2.84 kg). The HM group had a higher serum Ca level than SIM (10.75±.08 vs. 9.99±.21 mg/d1, p<.01). Again, at 12-16 wks, there were no differences in BMC (x, 104 for HM vs. 88 mg/cm for SIM), Ca (X, 10.75 vs. 10.66 mg/d1), AP (x, 134 vs. 144 IU/L) or 25-OH D (X, 16 vs. 20 ng/ml) or weight (X, 4.26 kg for HM vs. 4.83 kg for SIM, p< .20). Our preliminary data suggest that human milk provides sufficient nutrients for bone mineralization in premature infants.

620 THE EFFECTS OF HUMAN MILK AND LOW PROTEIN FORMULAE ON THE PROTEIN METABOLISM OF PRETERM INFANTS

The effects of pooled mature human milk and two low protein formulae (whey or casein predominant) on the rates of whole body amino nitrogen flux (Q), protein synthesis (S) and breakdown (B) were studied in 30 preterm appropriate for gestational age infants, birth weights 1500-2000 g. The infants were studied once they were receiving approximately 120 kcal/kg/d. Intakes of total nitrogen and energy were similar in all 3 groups as were nitrogen balances and length and weight growth. Rates of Q, S and C are all significantly increased (p<0.01) in the human milk group. The only apparent explanation for this difference is the lower true protein intake (p<0.01). These results suggest that preterm infants adapt metabolically to a lower protein intake by a more intense recycling of endogenous proteins and amino acids. Furthermore, the level of protein intake received by the breast fed group may approximate the lowest limit of protein requirement, as any further reduction would probably exceed the limits of metabolic adaptation.

Comparing the Impact of Topical Application of Human Milk and Chlorhexidine on Cord Separation Time in Newborns.

Objectives:The best umbilical cord care after birth is a controversial issue. Aim of this research was to compare the effect of topical application of human milk and chlorhexidin on cord separation time in newborns.Methods:One hundred seventy four neonates attending from hospitals affiliated to Kashan University of Medical Sciences were included. Newborns from birth were randomized to two groups. In group mother’s milk, mother will rub her own milk to cord stump two times a day. chlorhexidin (group 2) were applied to the umbilical stump every 12 hours. The time to umbilical cord separation and any discomfort such as infection, hemorrhage, and discharge and odor were documented. Data was analyzed by SPSS software. Independent Samples t-Test, χ2, Fisher were used in this study.Results:Results showed a significant statistical difference between cord separation time in two groups and the mean cord separation time in the human milk group (7.15±2.15days) was shorter than the chlorhexidin group (13.28±6.79 days). In addition, a significant correlation was found between Signs of infection (discharge, redness, swelling and odor) in both groups.Conclusions:Topical application of breast milk on umbilical cord care leads to quick cord separation time and can be used as easy, cheep, non injury methods for umbilical cord care.