Fortifier selection and dosage enables control of breast milk osmolarity

Barbero, Ana Herranz; Rico, Nayra; Oller‐Salvia, Benjamí; Aldecoa‐Bilbao, Victoria; Macías-Muñoz, Laura; Wijngaard, Robin; Figueras‐Aloy, Josep; Salvia-Roigés, MaDolors

doi:10.1371/journal.pone.0233924

Cited by 4 publications

(4 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study we obtained greater values of osmolality in our FMOM preparations (done according to the manufacturer’s instructions) than those specified by commercial fortifier companies (< 450 mOsm/kg). This is fully in line with previous research (Herranz Barbero et al, 2020; Rosas et al, 2016).…”

Section: Discussionsupporting

confidence: 94%

Quality Assurance in Lactation: Reliability of OM-6050 Station System to Test Mother’s Milk Osmolality

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Mother’s own milk does not provide enough nutrients to feed a preterm baby born before 32 weeks’ gestation; therefore, human milk fortifiers are needed. However, human milk fortifiers increase the osmolality, and enteral administration of high osmolality fluids has been associated with gastrointestinal symptoms. For this reason, it is necessary for laboratories to have a validated system in order to measure human milk osmolality. Research aim The aim of this study was to validate the OM-6050 Station System for measuring the osmolality of fortified mother’s milk samples. Methods Osmolality was measured using the osmometer OM-6050 Station System. Milk samples from healthy mothers ( N = 3) unfortified and with two fortifiers (Almirón Fortifier® or NAN FM85®), as well as a nutritional supplement (Duocal MCT®) were used in the validation study through precision and linearity analysis. Results In the precision study the mean intra-assay coefficient of variation was 1.2% and 1.7% for mother’s milk and fortified mother’s milk, respectively. The mean inter-assay coefficient of variation was ≤ 1% in both cases. In the linearity study the regression analysis had a linear response to fortified mother’s milk osmolality between 294 mOsm/kg and 539 mOsm/kg. Conclusion The osmometer OM-6050 Station was reliable for determining the osmolality of fortified and unfortified mother’s milk. It may be useful in the clinical practices within Neonatal Intensive Care Units.

show abstract

Section: Discussionsupporting

confidence: 94%

Quality Assurance in Lactation: Reliability of OM-6050 Station System to Test Mother’s Milk Osmolality

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Our data are reassuring since mean osmolality of DHM and preterm MOM generally remained below the AAP recommended safety cut-off value of 450 mOsm/kg [ 7 ]. These results confirm previous studies which investigated the effect of FM85 addition to DHM [ 12 , 13 ] and preterm MOM [ 14 ]. Conversely, studies which investigated the effect of fortifiers other than FM85 and Aptamil BMF on osmolality of DHM [ 6 , 15 ] and MOM [ 15 , 16 ] showed an increase of osmolality over 450 mOsm/kg.…”

Section: Discussionsupporting

confidence: 92%

“…It is noteworthy that previous studies [ 12 , 14 — 17 ], except for Piemontese et al [ 13 ], evaluated changes of osmolality only in the first 24 h after fortification. This evidence of lack of changes allowed fortification of HM once a day rather than before each feed contributing to a decrease in handling of HM and workload of nurses.…”

Section: Discussionmentioning

confidence: 99%

Effect of fortification on the osmolality of human milk

Elia¹,

Ciarcià²,

Cini³

et al. 2023

Ital J Pediatr

View full text Add to dashboard Cite

Background It is known that human milk fortifiers (HMF) increases osmolality of human milk (HM) but some aspects of fortification have not been deeply investigated. Our aim was to evaluate the effect of fortification on the osmolality of donor human milk (DHM) and mother’s own milk (MOM) over 72 h of storage using two commercial fortifiers and medium-chain triglycerides (MCT) supplementation. Methods Pasteurized DHM and unpasteurized preterm MOM were fortified with 4% PreNAN FM85, 4% PreNAN FM85 plus 2% MCT, or 4% Aptamil BMF. Osmolality was measured in unfortified DHM and MOM and, moreover, just after fortification (T0), and after 6 (T6), 24 (T24) and 72 h (T72) to determine the effect of mixing and storage. Results Unfortified DHM and MOM did not show changes of osmolality. Fortification increased osmolality of DHM and MOM without changes during the study period, except for Aptamil BMF which increased osmolality of MOM. The addition of MCT to fortified human milk (FHM) did not affect its osmolality. Conclusions Changes of osmolality in the 72 h following fortification of both DHM and MOM did not exceed the safety values supporting the theoretically possibility of preparing 72 h volumes of FHM. Supplementation with MCT of FHM does not change osmolality suggesting that increasing energy intake in preterm infants via this approach is safe.

show abstract

“…Mother's own milk (MOM) and donor human milk (DHM) are the preferred sources of nutrients for VPIs, but do not contain adequate nutrients and energy for optimal growth thus requiring nutrient fortification [3]. Most nutrient fortifiers are formula products based on bovine milk (bovine milk-based fortifiers, BMBFs), generally being subject to extensive processing involving protein pre-hydrolysis and often added plant-based ingredients [4]. Unfortunately, such fortifiers have been associated with an increased risk of gut-related complications [5].…”

Section: Introductionmentioning

confidence: 99%

Gut microbiota development in very preterm infants following fortification of human milk

Yang,

Hui,

Sangild

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Very preterm infants (VPIs) are born with an immature gut, being sensitive to gut microbiota dysbiosis-related disease like necrotizing enterocolitis. While human milk is the best source of nutrition for VPIs, it requires fortification to meet their nutrient requirements for optimal growth. However, the optimal type of fortifier remains uncertain. Bovine colostrum (BC), rich in protein and bioactive components, may be an alternative to conventional fortifiers (CF). We aimed to investigate the distinct impacts of different bovine fortifiers, BC and CF, on the gut microbiota of VPIs. The gut microbiota of 225 VPIs who were fed human milk fortified with either BC or CF, were profiled by 16S rRNA gene amplicon sequencing of fecal samples collected before, one and two weeks of fortification. Results: Fortifier type affected the microbial community structure to a modest extent, but only explaining 1% of the variance, and no specific taxa differed between the BC and CF groups. This fortifier-derived impact was predominantly observed in VPIs born via caesarean section. Birth mode exhibited transient effects on microbial community structure shortly after birth, with caesarean section-born VPIs dominated by Firmicutes, while vaginally-born VPIs were dominated by Proteobacteria. This birth mode-derived difference diminished with age and disappeared around one month after birth. The fecal pH, increased by BC, was positively correlated with Staphylococcus and Corynebacterium, and negatively with Bifidobacterium abundance. The change in relative abundance of Staphylococcus was negatively correlated with weight gain. Conclusion: Collectively, fortification of human milk with BC or CF does influence the gut microbiota of VPIs but only to a modest extent during early life. Conversely, birth mode appears to be a significant temporary factor influencing the gut microbiota during this period. Our findings are consistent with existing literature and support the idea that the choice of fortifier has limited effects on gut microbiota development in the first month of life of VPIs.

show abstract

Fortifier selection and dosage enables control of breast milk osmolarity

Cited by 4 publications

References 37 publications

Quality Assurance in Lactation: Reliability of OM-6050 Station System to Test Mother’s Milk Osmolality

Quality Assurance in Lactation: Reliability of OM-6050 Station System to Test Mother’s Milk Osmolality

Effect of fortification on the osmolality of human milk

Gut microbiota development in very preterm infants following fortification of human milk

Contact Info

Product

Resources

About