Human Milk Preparation Research Articles

Perceptions of the impact of a multidose human-milk fortifier on human-milk preparation practices in United States neonatal intensive care units: A survey of nutrition care team members.

In 2020, a multidose human-milk fortifier (MDHMF) was designed to improve the process of human-milk (HM) fortification. The bottle of MDHMF (5.5 oz, 163 ml) allows aseptic removal of HMF in a precise measure. This survey aimed to examine the experience of nutrition care team (NCT) members who used the MDHMF in a hospital setting. A survey link (Qualtrics XM) was sent to NCT leaders (N = 108) at hospitals who participated in an evaluation of the MDHMF from June 1, 2020, through April 30, 2021. The NCT leaders sent the survey to members at their prospective hospitals (n = 344). The investigators did not know the identities of the recipients of the survey and collected no identifying information on respondents. Respondents were asked to evaluate their experience with the MDHMF compared with their previous practice. The majority of respondents (n = 63, 72%) reported that the MDHMF improved their HM preparation practices and was better than their previous practice for reducing the time to prepare (n = 33, 71.7%), ensuring the accuracy of fortified HM (n = 32, 69.6%), ensuring aseptic preparation (n = 24, 52.2%), reducing HM waste (n = 27, 58.7%), and being easy to use (n = 30, 65.2%). Those responsible for evaluating nutrition status answered that the MDHMF was the same for feeding tolerance (n = 41, 58.6%), weight gain (n = 47, 67.1%), head growth (n = 56, 81.2%), and length growth (n = 53, 76.8%). US neonatal intensive care unit NCT members perceived that the MDHMF resulted in improved HM preparation practices while maintaining growth and tolerance.

NICU Discharge Feeding Bundle Improves Accuracy of Postdischarge Feeding Preparation and Potentially Prevents Readmission.

Hospitalized infants often need fortified human milk and formulas for growth in the neonatal intensive care unit and postdischarge. Parents must learn how to properly mix infant feedings.At the initial Children's Hospital Colorado follow-up visit, baseline data revealed a 50% rate of mixing inaccuracy of discharge feeding recipes and identified the readmission of 2 infants with life-threatening hypernatremia. A gap in discharge teaching was identified. A quality improvement project was implemented at 2 affiliated neonatal intensive care units. The aim of this study was to improve parental comfort and efficacy in infant feeding preparation during hospitalization, reduce mixing inaccuracy postdischarge, and prevent readmission. The primary aim was to improve the accuracy rate at follow-up to 75% within 12 months and the sustain mixing accuracy rate at follow-up to above 95% for an additional 24 months. A literature review was conducted; potential barriers were identified and strategies developed to recognize the relationships between the aim and the changes to be tested. Implementation of standardized teaching focused on the teach-back technique. Education included mixing demonstration and written instructions. Parents were expected to correctly mix the recipe 3 times before discharge. Mixing accuracy at the initial clinic follow-up visit improved to 97%. No readmissions were reported from inaccurately prepared feedings. Collaborative quality improvement project with standardized teaching provided improved feeding safety and parental comfort with accuracy of discharge instructions. Primary care providers need to be aware of the importance of accurate formula or fortified human milk preparation and verify accuracy of the specific discharge recipes at the initial visit.

A Pilot Study of Human Milk to Reduce Intestinal Inflammation After Bone Marrow Transplant.

Human milk administration in the early peritransplant period would lower intestinal inflammation after bone marrow transplant (BMT). Children 0-5 years undergoing BMT received either a ready-to-feed human milk preparation designed for these children (Prolacta Bioscience, Duarte, CA) or standard formula. Babies breastfeeding at the time of BMT were also enrolled on the human milk arm. Human milk was administered from day -3 until day +14 after BMT. Metagenomic shotgun sequencing and metabolomics of stool, plasma cytokines, and regenerating islet-derived 3α (REG3α) levels were measured at enrollment and day +14. Human leukocyte antigen-DR isotype (HLA-DR), CD38, and CD69 expression on T cells were evaluated at day +21. Forty-six children were enrolled, 32 received human milk (donor milk n = 23, breastfeeding babies n = 9), and 14 were controls who received standard feeds supervised by a BMT dietician. Twenty-four patients received at least 60% of goal human milk and were evaluable. Plasma interleukin (IL)-8 (p = 0.04), IL-10 (p = 0.02), and REG3α (p = 0.03) were decreased in the human milk cohort. Peripheral blood CD69+ CD8+ T cells were higher in controls (p = 0.01). Species abundance of Adenovirus (p = 0.00034), Escherichia coli (p = 0.0017), Cryptosporidium parvum (p = 0.0006), Dialister invisus (p = 0.01), and Pseudomonas aeruginosa (p = 0.05) from stool was higher in controls. Stool alanine, tyrosine, methionine, and the ratio of fecal alanine to choline and phosphocholine were higher in controls (p < 0.05). No difference was observed in stool propionate and butyrate levels as measures of short-chain fatty acids between the two cohorts. Administration of human milk resulted in decreased markers of intestinal inflammation and could be a valuable adjunct for patients after BMT.

Centralized Model of Human Milk Preparation and Storage in a State-of-the-Art Human Milk Lab

Strategies to ensure safe handling and administration of human milk for sick, hospitalized infants are necessary to avoid compromising the integrity of the milk and to prevent administration to the wrong patient. A centralized system of storing and preparing human milk in a milk lab that incorporates multiple verification points using a bar-coding system ensures that the right milk is prepared, delivered, and administered to the right patient, at the right time, and with the right additives. A team of skilled technicians dedicated to handling and preparing human milk, and a system of careful temperature control of refrigerators, freezers, water baths, and warmers, ensures the safety and quality of the milk. Nurses spend less time away from the bedside and more time in patient care when the milk is stored and prepared in a milk lab and delivered ready-to-feed to the bedside. Patient and staff satisfaction are high when a centralized system of storing and preparing human milk is implemented in the hospital setting.

Growth and Development of a Hospital-based Lactation Program and Mother’s Own Milk Bank

This article describes the development and characteristics of a hospital-based lactation program and mother's own milk bank in a large pediatric hospital in the southwestern United States. Professional and technical staffing, physical space of the milk bank area, and the program's services and special features are outlined. Quality control issues about human milk preparation, fortification, storage, and transport are discussed.

Postnatal attainment of intrauterine macromineral accretion rates in low birth weight infants fed fortified human milk

Hypothesis: Provision of more bioavailable mineral sources as human milk supplements enables very low birth weight (VLBW) infants to meet the intrauterine accretion rate for calcium and phosphorus. Design: Comparison of currently formulated human milk fortifier with previous formulation. Setting: Neonatal level II and III nurseries Patients: Twenty-six healthy, VLBW infants, whose mothers chose to breast-feed. Interventions: We tested the effects of two formulations designed for VLBW infants as human milk supplements and differing primarily in their quantity and source of Ca, P, and magnesium. The study interval began with a milk intake of 100 ml · kg -1 · day -1 and ended when a body weight reached 2.0 kg. Main outcome measures: Net absorption and retention of Ca, P, and Mg during a nutritional balance study conducted once during the study interval, growth during the entire study interval, and bone mineral content of the radius were measured at the beginning and end of the study interval. Results: The newer Ca gluconate-glycerophosphate preparation (given to group CaGP) resulted in greater net absorption and retention of Ca and P ( p <0.01) than in infants given Ca phosphate (group CaTB). Mg retention was greater than (in group CaGP) or equivalent to (in group CaTB) the intrauterine accretion rate. Radius bone mineral content was significantly greater in group CaGP than in group CaTB ( p <0.001). Volumes of the fortified human milk preparation needed to meet the needs for gain in body weight were higher in group CaGP than in group CaTB ( p <0.001). Conclusions: Intrauterine accretion rates for Ca and P can be achieved when VLBW infants are fed human milk supplemented with Ca gluconate-glycerophosphate. Supplementation of human milk with Mg may not be indicated. In this study, greater intakes of Ca and P, and not improvements in bioavailability, result in improved net retention and bone mineral content of VLBW infants. (J P ediatr 1995;126:441-7)

Protein Supplementation of Human Milk for the Nutrition of VLBW-Infants: Human milk protein vs. meat protein hydrolysate

In 25 very low birth weight infants appropriate for gestational age the influences of different human milk (HM) preparations on weight gain, gross indices of nitrogen metabolism and energy balance were studied during the second month of postnatal life. HM was fortified either by HM-protein (HMP) or by an enzymatic meat protein hydrolysate (PH) to protein concentrations between 1.5 and 1.7 g/100 ml. The caloric densities of both HM preparations were similar between 62 and 68 kcal/100 ml. There were no differences in weight gain (MM + HMP: 18.6 +/- 3.4 g/kg/day; HM + PH: 16.5 +/- 4.1 g/kg/day), nitrogen retention (HM + HMP: 31.5 +/- 3.1 mmol/kg/day; HM + PH: 30.0 +/- 3.2 mmol/kg/day), and the preprandial estimated essential amino acid profiles between the both feeding groups. In contrast the serum concentrations of alpha-amino-nitrogen 60 minutes postprandially were elevated in the infants fed HM + PH in comparison to the infants fed HM + HMP. This high postprandial amino acid concentrations in serum in the group fed HM + PH were accompanied by increased bile acids concentrations in serum, higher renal amino acid excretion and increased fecal fat losses. The results suggest that due to the more rapid intestinal absorption of amino acids from PH than from HMP the concentrations of amino acids increase postprandially which results in a detectable increase of the newborn cholestasis in these infants. Nevertheless, the scale of these metabolic responses to feeding protein hydrolysates is small and without detectable influences on nitrogen retention or weight gain.

Molecular Forms of Lactoferrin in Stool and Urine from Infants Fed Human Milk

The molecular forms of lactoferrin (LF) were examined in stools and urine collected at 2.5 or 5 wk of age from very low birth wt infants fed either a cow's milk formula or a fortified human milk preparation. LF was not found by Western blotting in excreta from infants fed cow's milk. In contrast, intact and fragmented forms of LF were detected in stools and concentrated urine of each infant who received human milk. Only intact LF was detected in the fortified human milk preparation, whereas many types of LF fragments were present in the stools and urine. The approximate molecular wt of the most prominent fragments were 44, 38, 34, and 32 kD. However, the stools also displayed lower molecular wt fragments that were not found in urines of those infants. The LF fragments in those excreta were similar in size to those produced in vitro by limited digestion of apo-LF with trypsin. Furthermore, fragments produced by in vitro proteolysis were immunoreactive in an ELISA for LF. Thus, the fragments of LF in stools of very low birth wt infants fed human milk appeared to be produced by in vivo proteolysis, and the close resemblance between the LF fragments in the stools and urine suggests that the urinary LF fragments originated in the gastrointestinal tract. It remains unclear, however, whether the whole LF molecules that were fragmented were derived solely from ingested LF in human milk or in part from LF produced by the infant in response to human milk feedings.

Human milk and the rate of small intestinal mucosal recovery in protracted diarrhea

Study objective: To determine whether human milk accelerates the recovery rate of injured small intestinal mucosa. Design: Randomized, controlled trial. Setting: County and nonprofit, private urban hospitals. Patients: Moderately to severely mainourished infants less than 6 months of age who required parenteral nutrition for treatment of protracted diarrhea. Interventions: Either a human milk preparation (n=7) or sterile water (n=9) was administered by continuous nasogastric feeding (14 mL/kg/d) over a 2-week study period while the infants received parenteral nutrition. Measurements and main results: Small intestine perfusion studies and biopsies were performed at the beginning and end of the study. Age, duration of prior illness, severity of mainutrition, glucose and water absorption, disaccharidase activities, atrophy of vill, and nutritional intake were comparable in both groups of infants. At the end of the 2-week study, improvement toward normal sucrase activity and intraepithellal lymphocytes was found in significantly fewer infants in the milk group than in the water group. No differences were noted in glucose and water absorption or in lactase and maltase activities as a function of the milk versus water treatment. Conclusions: Human milk did not accelerate functional recovery of the small intestinal mucosa.

727 COMPARISON OF THE EFFICACY OF CA AND P FORTIFICATION IN HUMAN MILK

Calcium (Ca) and phosphorus (P) deficiency was observed in earlier studies of 17 preterm infants fed a preparation of fortified mother's milk derived from pasteurized, lyophilized fractions of mature human milk (Group I, birthweight, 1178 ± 36 g, gestation, 29 ± 0.2 wk, Mean ± SEM). A modified preparation of this fortified mother's milk with added Ca lactate and P salts was fed to 8 infants (Group II, 1088 ± 53 g, 28 ± 0.3 wk) for the first two months postnatally. 96-h balance studies were conducted at approximately weeks 3 and 7. Group II achieved significantly greater intakes (CaI, PI), retentions (CaR, PR), and absorptions (CaABS, PABS) of both Ca and P, and greater urinary excretion of P(PU). Proportionally greater urinary excretion of Ca(CaU) was observed in Group I (P = 0.003). Serum P was greater and alkaline phosphatase was lower in Group II (P < 0.01). These results indicate that the addition of both Ca and P to fortified mother's milk will reverse Ca and P insufficiency and lead to retentions of Ca and P which approach the fetal accretion more closely than previous human milk preparations.