Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on HM macronutrient content is necessary to optimize nutritional support of preterm infants.
Objectives:
This study aimed to describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient contents in HM given to these infants.
Methods:
A population-based study of Swedish extremely preterm infants (n = 586) born before 27 gestational weeks was conducted. Data on ingested volumes of different milk during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis.
Results:
During the first 4 weeks of life, 99% of the infants were exclusively fed HM, and at 4 weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples was analyzed. Protein content in MOM decreased significantly from 2.2 to 1.2 g/100 mL during the first 112 postpartum days, whereas fat and energy content were highly variable within and between MOM samples. In addition, 354 samples of donor milk were analyzed. Content of protein, fat, and energy in pooled donor milk (n = 129) was lower compared to single donor milk.
Conclusion:
Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates, and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow more individualized nutritional support for these vulnerable infants.
American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.
2.
TaylorSNBasileLAEbelingMWagnerCL. Intestinal permeability in preterm infants by feeding type: mother’s milk versus formula. Breastfeed Med. 2009;4(1):11-15.
3.
ArslanogluSCorpeleijnWMoroG. Donor human milk for preterm infants: current evidence and research directions. J Pediatr Gastroenterol Nutr. 2013;57(4):535-542.
4.
BoydCAQuigleyMABrocklehurstP. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2007;92(3):F169-F175.
5.
VohrBRPoindexterBBDusickAM. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007;120(4):e953-e959.
6.
WeberALouiAJochumFBuhrerCObladenM. Breast milk from mothers of very low birthweight infants: variability in fat and protein content. Acta Paediatr. 2001;90(7):772-775.
7.
MichaelsenKFPedersenSBSkafteLJaegerPPeitersenB. Infrared analysis for determining macronutrients in human milk. J Pediatr Gastroenterol Nutr. 1988;7(2):229-235.
8.
CasadioYSWilliamsTMLaiCTOlssonSEHepworthARHartmannPE. Evaluation of a mid-infrared analyzer for the determination of the macronutrient composition of human milk. J Hum Lact. 2010;26(4):376-383.
9.
OmarsdottirSCasperCAkermanAPolbergerSVanpeeM. Breastmilk handling routines for preterm infants in Sweden: a national cross-sectional study. Breastfeed Med. 2008;3(3):165-170.
PolbergerSLonnerdalB. Simple and rapid macronutrient analysis of human milk for individualized fortification: basis for improved nutritional management of very-low-birth-weight infants?J Pediatr Gastroenterol Nutr. 1993;17(3):283-290.
12.
The EXPRESS Group. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009;301(21):2225-2233.
13.
The EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr. 2010;99(7):978-992.
14.
Stoltz SjostromEOhlundIAhlssonF. Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study. Acta Paediatr. 2013;102(11):1067-1074.
15.
McGuireWHendersonGFowliePW. Feeding the preterm infant. BMJ. 2004;329(7476):1227-1230.
16.
MerrillALWattBK. Energy Value of Foods, Basis and Derivation. Washington, DC: US Department of Agriculture; 1973:105. Agriculture Handbook No. 74.
17.
LandersSUpdegroveK. Bacteriological screening of donor human milk before and after Holder pasteurization. Breastfeed Med. 2010;5(3):117-121.
18.
TullyDBJonesFTullyMR. Donor milk: what’s in it and what’s not. J Hum Lact. 2001;17(2):152-155.
19.
R Development Core Team. R: A language and environment for statistical computing. Vienna, Austria: The R Foundation for Statistical Computing. http://www.R-project.org/. Published 2011. Accessed July 13, 2014.
20.
WoodSN. Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models. Journal of the Royal Statistical Society Series B–Statistical Methodology. 2011;73(1):3-36.
21.
BauerJGerssJ. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clin Nutr. 2011;30(2):215-220.
22.
AndersonGHAtkinsonSABryanMH. Energy and macronutrient content of human milk during early lactation from mothers giving birth prematurely and at term. Am J Clin Nutr. 1981;34(2):258-265.
23.
NevilleMCMortonJ. Physiology and endocrine changes underlying human lactogenesis II. J Nutr. 2001;131(11):3005S-3008S.
24.
DeweyKGNommsen-RiversLAHeinigMJCohenRJ. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003;112(3, pt 1):607-619.
25.
ParkerLASullivanSKruegerCKelechiTMuellerM. Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol. 2012;32(3):205-209.
26.
ZachariassenGFenger-GronJHviidMVHalkenS. The content of macronutrients in milk from mothers of very preterm infants is highly variable. Dan Med J. 2013;60(6):A4631.
27.
American Academy of PediatricsPediatric Nutrition Handbook. 6th ed.Elk Grove Village, IL: American Academy of Pediatrics; 2008:79-84.
28.
AgostoniCBuonocoreGCarnielliVP. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50(1):85-91.
29.
RigoJ. Protein, amino acid and other nitrogen compounds. In: TsangRUauyRKoletzskoBZlotkinS, eds. Nutrition of the Preterm Infant, Scientific Basis and Practical Guidelines. 2nd ed.Cincinnati, OH: Digital Educational Publishing, Inc; 2005:45-80.
30.
de HalleuxVRigoJ. Variability in human milk composition: benefit of individualized fortification in very-low-birth-weight infants. Am J Clin Nutr. 2013;98(2):529S-535S.
31.
ArslanogluSMoroGEZieglerEE; WAPM Working Group on Nutrition. Optimization of human milk fortification for preterm infants: new concepts and recommendations. J Perinat Med. 2010;38(3):233-238.
32.
FaerkJSkafteLPetersenSPeitersenBMichaelsenKF. Macronutrients in milk from mothers delivering preterm. Adv Exp Med Biol. 2001;501:409-413.
33.
NevilleMCAllenJCArcherPC. Studies in human lactation: milk volume and nutrient composition during weaning and lactogenesis. Am J Clin Nutr. 1991;54(1):81-92.
34.
HendersonJJHartmannPENewnhamJPSimmerK. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women. Pediatrics. 2008;121(1):e92-e100.
35.
WojcikKYRechtmanDJLeeMLMontoyaAMedoET. Macronutrient analysis of a nationwide sample of donor breast milk. J Am Diet Assoc. 2009;109(1):137-140.
36.
CooperARBarnettDGentlesECairnsLSimpsonJH. Macronutrient content of donor human breast milk. Arch Dis Child Fetal Neonatal Ed. 2013;98(6):F539-F541.
37.
MichaelsenKFSkafteLBadsbergJHJorgensenM. Variation in macronutrients in human bank milk: influencing factors and implications for human milk banking. J Pediatr Gastroenterol Nutr. 1990;11(2):229-239.
