Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

Abstract

Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth-particularly brain development-that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification-including targeted and adjusted fortification-show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.

Keywords: breast milk; fortification; neurodevelopment; preterm.

Figure 1

(A) Comparison of mother’s own milk and donor human milk mean macronutrient content (protein, lactose and fat; g/100 mL). (B) Comparison of mother’s own milk and donor human milk mean energy content. Means extracted from Piemontese et al. and Zachariassen et al. The values presented represent native (unfortified) human milk [37,41]. * Values representing the weeks after delivery are indicative of the mother’s own milk averages, whereas the donor human milk (DHM) averages represent over 90% of donor milk mothers who delivered after 37 weeks’ gestation. Donation began 2.9 ± 2.3 months after delivery [37].