Supplementation of Pooled Human Milk with Casein Hydrolysate: Energy and Nitrogen Balance and Weight Gain Composition in Very Low Birth Weight Infants

Abstract

[J.R., J.S.] ABSTRACI'. Growth and nitrogen and energy balances pooled pasteurized human milk had a low protein retention but were studied with a combined technique of nutrient balance also a high rate of fat deposition. These data suggested that and indirect calorimetry measurement in two groups of protein, rather than energy, should be added to pooled human eight very low birth weight infants fed pooled pasteurized milk. human milk (HM) or cow's milk casein hydrolysate sup-The aim of the present study was to compare nutrient and plemented H M (HM-Pr). There was no difference in the energy balance in two groups of VLBW boys fed either pooled amount of energy absorbed (91 f 17 kcal/kg/day with human milk or pooled human milk supplemented with hydro-HM-Pr versus 95 +: 8 with HM-P) or in the growth rate. lyzed cow's milk casein.The infants fed HM-Pr had a higher nitrogen intake (602 Infants. Eight VLBW boys of appropriate weight for gestational mg/kg/day; p < 0-01)-They had increased plasma age were investigated in each group (Table I). Informed parental concentrations of essential amino acids, urea nitrogen, and consent was obtained for each infant. N~~~ of the infants had total protein without metabolic imbalance. Energy expend-any medical problem at the time of the study. iture was higher (58 versus 49 kcal/kg/day;p < 0.005) andFeeding. The infants received an amino acid and glucose energy storage lower (33 versus 47 kcal/kg/day; p < 0s05) solution given parenterally from admission until oral feeding had with HM-Pr-In percent of weight gain, protein and fat reached an adequate volume. For all infants oral feeding was accretion represented 12 and 14% in HM-Pr group versus started within 24 to 48 h with pasteurized pooled expressed 10 and 27% in HM group. Very low birth weight infants human milk. Once the full diet had been reached, the infants fed casein hydrolysate supplemented pooled H M iichieved either continued on pooled HM (HM group) or on pooled HM a growth rate and a weight gain composition similar to the supplemented with milk casein hydrolysate (HM-P~ fetus. (Pediatr Res 21: 458-461, 1987) group). The casein hydrolysate (Peptones, Gallia, France), which is produced by enzymatic hydrolysis of cow's milk casein, conAbbreviations sists mainly of polypeptides with a molecular weight below 3500 HM, pooled pasteurized human milk daltons and has a low free amino acid and fat content (Table 2). In practice 1 g of casein hydrolysate is mixed with 100 ml of HM-Pr, pooled pasteurized human supplemented pooled HM. This increases slightly the total energy content of with hydrolyzed cow's milk casein RQ, respiratory quotient HM (+ 4.3 kcal/dl) but changes the nonprotein energy content VOz, oxygen consumption (+ 0.14 kcalldl) very little. In the HM-Pr group the study was VC02, carbon dioxide production performed after at least 2 wk of full feeding with the protein-VLBW, very low birth weight supplemented milk. At the time of the study all infants were fed by nasogastric tube every 3 h and were growing steadily....

Weight Gain Composition in Preterm Infants with Dual Energy X-Ray Absorptiometry

“…, respectively, in the FHM and PTF groups are comparable to data reported in similar groups of preterm infants (8,9,24,25). The overall weight gain during the period of study was 630 and 913 g in the two groups, an increase of 42 and 63% over initial body weight.…”

“…Measurement of body composition is of fundamental importance in the nutritional care for preterm infants, and many techniques have been developed (3)(4)(5)(6)(7). Metabolic balances associated with indirect calorimetry allowed the composition of weight gain in preterm infants to be defined (8,9). The complexity of such techniques and the fact that weight gain composition could only be obtained over a short period of time resulted in the need for a new and reliable method of study.…”

The Use of Low-EPA Fish Oil for Long-Chain Polyunsaturated Fatty Acid Supplementation of Preterm Infants

“…From enrollment until discharge, these infants received 100% of their enteral intake as prefrozen milk from their mother supplemented with a standardized human milk fortifier (Eoprotin®, Milupa, Friedrichsdorf, Germany) to assure adequate macro-and micronutrient intake (24). After discharge, the mothers were encouraged to continue breastfeeding as long as possible.…”

Energy Expenditure in Premature Newborns with Bronchopulmonary Dysplasia

“…The reference commonly used is the fetus of the same gesta tional age [2], This growth rate, whose compo sition is estimated by energy balance studies and indirect calorimetry, can be obtained in healthy premature infants fed human milk enriched in minerals and protein [3], During the course of the neonatal period, some premature infants suffer from broncho pulmonary dysplasia (BPD) that extends beyond the first month [4], The incidence of this respiratory insufficiency is high. In 1985 in the region of Paris, 13% of the infants born before 33 weeks of gestation and surviving until the 28th day had respiratory sequelae [5,6].…”