Liquid Human Milk Fortifier Research Articles

Liquid human milk fortifier significantly improves docosahexaenoic and arachidonic acid status in preterm infants

We report the fatty acid composition of mother׳s own human milk from one of the largest US cohorts of lactating mothers of preterm infants. Milk fatty acid data were used as a proxy for intake at enrollment in infants (n=150) who received human milk with a powder human milk fortifier (HMF; Control) or liquid HMF [LHMF; provided additional 12mg docosahexaenoic acid (DHA), 20mg arachidonic acid (ARA)/100mL human milk]. Mothers provided milk samples (n=129) and reported maternal DHA consumption (n=128). Infant blood samples were drawn at study completion (Study Day 28). Human milk and infant PPL fatty acids were analyzed using capillary column gas chromatography.DHA and ARA were within ranges previously published for US term and preterm human milk. Compared to Control HMF (providing no DHA or ARA), human milk fortified with LHMF significantly increased infant PPL DHA and ARA and improved preterm infant DHA and ARA status.

A New Liquid Human Milk Fortifier and Linear Growth in Preterm Infants

To evaluate the growth, tolerance, and safety of a new ultraconcentrated liquid human milk fortifier (LHMF) designed to provide optimal nutrients for preterm infants receiving human breast milk in a safe, nonpowder formulation. Preterm infants with a body weight ≤ 1250 g fed expressed and/or donor breast milk were randomized to receive a control powder human milk fortifier (HMF) or a new LHMF for 28 days. When added to breast milk, the LHMF provided ∼20% more protein than the control HMF. Weight, length, head circumference, and serum prealbumin, albumin, blood urea nitrogen, electrolytes, and blood gases were measured. The occurrence of sepsis, necrotizing enterocolitis, and serious adverse events were monitored. This multicenter, third party-blinded, randomized controlled, prospective study enrolled 150 infants. Achieved weight and linear growth rate were significantly higher in the LHMF versus control groups (P = .04 and 0.03, respectively). Among infants who adhered closely to the protocol, the LHMF had a significantly higher achieved weight, length, head circumference, and linear growth rate than the control HMF (P = .004, P = .003, P = .04, and P = .01, respectively). There were no differences in measures of feeding tolerance or days to achieve full feeding volumes. Prealbumin, albumin, and blood urea nitrogen were higher in the LHMF group versus the control group (all P < .05). There was no difference in the incidence of confirmed sepsis or necrotizing enterocolitis. Use of a new LHMF in preterm infants instead of powder HMF is safe. Benefits of LHMF include improvements in growth and avoidance of the use of powder products in the NICU.

A New Liquid Human Milk Fortifier and Linear Growth in Preterm Infants

A New Liquid Human Milk Fortifier and Linear Growth in Preterm Infants

LINEAR GROWTH IN VERY PREMATURE INFANTS IS SIGNIFICANTLY RELATED TO PROTEIN INTAKE

BackgroundWe have previously shown that preterm infants fed human milk fortified with a liquid human milk fortifier (LHMF), which provides approximately 20% more protein than current powder fortifier (Control), have significantly greater linear growth. Previous studies have shown that preterm growth is a function of parenteral protein intake; however, this relationship for enteral protein has not been confirmed.ObjectiveTo assess linear growth as a function of protein intake.MethodsFifty‐six preterm infants (BW ≤1,250 g) fed expressed and/or donor breast milk were randomized to receive Control or LHMF for 28 days. Length and total protein intake (parenteral and enteral) were recorded.ResultsOn study day 28, LHMF fed infants were significantly longer than Control (42.4±0.28 cm vs. 41.2±0.24 cm, p=0.003). There was no difference between groups for total calorie intake (116.0±1.5 kcal/kg/d vs. 119.3±1.3 kcal/kg/d, p=0.113). The change in length in all infants was significantly related to total protein intake (p=0.0077) (see Figure); a similar relationship was not present for nonprotein calorie intake (p=0.12). This relationship was also dependent upon the fortifier consumed (p=0.0327).ConclusionLinear growth in preterm infants reflects protein intake regardless of route of delivery. The better length growth seen in LHMF infants appears to be due to the higher enteral protein it provides.

A Fortifier Comprising Protein, Vitamins, and Calcium-Glycerophosphate for Preterm Human Milk

Background The infant's own mother's milk, fortified with proteins, minerals, and vitamins, is considered the best food for low-birth-weight infants. This paper describes the process to obtain a liquid human milk fortifier. Methods The fortifier comprises a protein concentrate, calcium, phosphate, and zinc salts, as well as vitamins A and D. A powdered whey protein extracted from bovine milk was concentrated from 31.5–76.8 g/100 g using repetitive dialysis. The protein concentrate was dissolved in a 0.2 M phosphate buffer pH 7.4 and mixed with calcium-glycerophosphate and calcium-gluconate, vitamins A and D, folic acid, and zinc. Each 10 mL of this liquid fortifier has 0.78 g protein, 53 mg calcium, 36 mg phosphate, and 0.93 mg zinc. Results Repetitive dialysis did not modify the protein structure as demonstrated by electrophoresis. A total of 95% of lactose content was discarded. Enriching human milk using this human milk fortifier increased the concentration per deciliter of all added nutrients; proteins increased from 1.68–2.35 g, calcium from 26–90 mg, and phosphorus, from 15–51 mg. Conclusions A liquid human milk fortifier was successfully manufactured using a noncomplex procedure. An intake of 180–200 mL/kg/day of the fortified human milk by the premature infant would satisfy the infant's nutritional requirements and achieve expected growth and development.

Nutritional Balance Studies of VLBW Infants Fed Their Mothers' Milk Fortified with a Liquid Human Milk Fortifier

This article reports the results of a study designed to compare human milk fortified with a liquid human milk fortifier to a preterm infant formula by analyzing the metabolic balances of certain nutrients when these milks are fed to premature infants. Ten very low birth weight (VLBW) infants were studied during 4‐day equilibration periods, then 4‐day metabolic balances of N, fat, Ca and P. while each consumed a 1:1 mixture of a pool of its own mother's milk and the liquid human milk fortifier (HM/LF). For comparison, another 10 VLBW infants were studied in similar fashion while consuming the preterm infant formula (PF). Percent nitrogen retentions were 77 + 4% ( + SD) and 79 + 4%, and fat absorptions were 94 + 7% and 92 + 5% in the HM/LF and PF groups, respectively, and did not differ between the groups. Calcium retention was 86 + 21 mg/kg/day (51 + 12%) in the HM/LF group and 104 + 43 mg/kg/day (45 + 19%) in the PF group. The percent Ca retentions did not differ. Phosphorus retentions were 56 + 7 mg/kg/day (67 + 9%) and 77 + 18 mg/kg/day (61 + 14%) in the HM/LF and PF groups, respectively. Increases in weight, length, and occipitofrontal circumference (OFC) were similar and normal in both groups. We conclude that VLBW infants fed the HM/LF, mixed 1:1 with their mothers' milk, had rates of absorption and retention of Ca, P, N, and fat similar to rates found in the concurrent study of VLBW infants fed a commercially available PF.