Challenges in the practice of human milk nutrition in the neonatal intensive care unit

Human milk fortification strategies for improved in-hospital growth of preterm infants

“…Levels of protein, fat and sodium decline over time until they are similar to those seen in mature milk. 7,11,12 Challenges in the use of human milk for the premature infant include the availability of mother's own milk, sustainability of expressing milk when infants are not feeding on the breast, the effect of pasteurisation on the nutritional and immunological content of donor milk, and transmission of viruses, including human immunodeficiency virus. The most important challenge is probably that unfortified human milk does not meet the nutritional requirements of most preterm infants.…”

“…These include using mother's own milk (unpasteurised) rather than donor milk (which usually comes from mothers who gave birth at term); increasing the volume of milk; using more hind milk than foremilk; and, fortification. 7,8,12 In resource-poor settings where human milk fortifiers are not available, circumstantial evidence even proposes the addition of skim milk powder. 8 To the authors' knowledge (and confirmed by personal communication with Ziegler on 26/02/2015 8 ), there are no published reports on the use of skim milk powder as fortifier, and it may not supply sufficient trace minerals.…”

Establishing an integrated human milk banking approach to strengthen newborn care

“…35 This comprehensive approach to service provision enables HMBs to significantly expand their reach beyond the vulnerable neonates who need DHM and permits an even greater impact on infant health and newborn care. 38 In addition to DHM collection, processing and storage in ‘stand-alone' HMB models, an integrative approach establishes HMBs as welcoming hubs within hospitals where all mothers, regardless of their desire to donate milk, can access support for BF and Kangaroo Mother Care, 39, 40, 41 thus raising awareness of the importance of BF and markedly expanding the impact of HMBs. As natural centers of care for mothers and babies, this type of comprehensive HMB program can provide an active link to communities to improve neonatal health.…”

Missed Opportunities: The Cost of Suboptimal Breast Milk Feeding in the Neonatal Intensive Care Unit

“…Interventions to facilitate the provision of human milk by mothers of premature infants have been well-described and include collaboration among all stakeholders in the hospital, 15 consistency among staff in information provided about human milk, 16 assistance in initiating lactation and maintaining an adequate milk supply, 17,18 and encouragement and education from lactation experts and breastfeeding peer counselors. 19 On a larger scale, one could make a compelling argument that the dismal experiment of the 1960s and 1970s wherein formula feeding of healthy term infants was believed to be equivalent to human milk feeding has contributed to astronomical costs to society, including lost intelligence, loss (perhaps permanent) of the intestinal microbiota shaped by millions of years of evolution, and the resultant increases in a broad array of chronic disease processes.…”