Preterm human milk composition: a systematic literature review

Abstract

There are wide variations in the macronutrient values adopted by neonatal intensive care units and industry to fortify milk in efforts to achieve recommended intakes for preterm infants. Contributing to this is the variation in macronutrient composition of preterm milk between and within mothers and the variable quality of milk analyses used to determine the macronutrient content of milk. We conducted a systematic review of the literature using articles published in English between 1959 and 2013 that reported the concentrations of one or more macronutrients or energy content in human preterm milk, sampled over a representative 24-h period. Searched medical databases included Ovid Medline, Scopus, CINAHL and the Cochrane Library. Results are presented as mean values and ranges for each macronutrient during weeks 1-8 of lactation, and preferred mean values (g/100 ml) for colostrum (week 1) and mature milk (weeks 2-8; protein: 1·27, fat: 3·46, lactose: 6·15 and carbohydrate: 7·34), using data from studies employing the highest-quality analyses. Industry-directed fortification practices using these mean values fail to meet protein targets for infants weighing <1000 g when the fortified milk is fed <170-190 ml/kg per d, and the protein:energy ratio of the fortified milk is inadequate. This study aimed to provide additional information to industry in order to guide their future formulation of breast milk fortifiers. Quality macronutrient analyses of adequately sampled preterm breast milk would improve our understanding of the level of fortification needed to meet recommended protein and energy intakes and growth targets, as well as support standardised reporting of nutritional outcomes.

Nutritional therapies in the neonatal intensive care unit and post‐natal growth outcomes of preterm very low birthweight Asian infants

“…The total amount of protein received in parenteral and enteral nutrition for each infant was calculated. Human milk protein content was estimated at 1.3 g/100 mL, and estimated energy values of 66 kcal/100 mL in human milk were used to calculate total energy intake of infants …”

Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants

“…Energy and selected nutrients intakes (protein, vitamin A and D, calcium, phosphorus, zinc, and iron), at 2-, 4-, and 6-moCA were estimated using HM composition values from literatures [39,40] manufacturer label claims for PF, EF and TF, drug label of MVD and ferrous fumarate drop, commercial complementary feeding formula and complementary foods composition recommended by the Thai Ministry of Public Health [36]. …”

“…The energy and nutrients values of fortified HM and EF used in the intervention group and unfortified HM [39,40] and TF used in the comparison group are shown in Table 2. Brands of TF formula were derived from nutritional records at a follow-up clinic in the historical group.…”

Comparison of Calorie and Protein Intake of Very Low Birth Weight Infants Receiving Mother's Own Milk or Donor Milk When the Nutrient Composition of Human Milk Is Measured With a Breast Milk Analyzer

“…Whether from MOM or DBM, because unfortified HM will not meet the higher nutrient needs of premature infants, the use of human milk fortifiers (HMFs) to increase macronutrient and micronutrient concentration is the standard of care for VLBW infants . Historically in the clinical setting, fixed doses of HMF are added to MOM and DBM in a blind fashion, where the baseline macronutrient content of HM is assumed and a standard amount of HMF is added to achieve desired levels for calories and protein . Another method is targeted fortification (also described as adjustable fortification) in which nutrient intake is increased via individualized regimens based on either measured HM composition for calories and macronutrients or to reach specific nutrition goals .…”

“…15 Historically in the clinical setting, fixed doses of HMF are added to MOM and DBM in a blind fashion, where the baseline macronutrient content of HM is assumed and a standard amount of HMF is added to achieve desired levels for calories and protein. 13,16 Another method is targeted fortification (also described as adjustable fortification) in which nutrient intake is increased via individualized regimens based on either measured HM composition for calories and macronutrients or to reach specific nutrition goals. 13 Because unadulterated DBM is lower in calories and protein than preterm MOM, even with fortifiers it may fail to meet the nutrition needs of the VLBW infant.…”