MOTHER’S MILK FORTIFICATION – Why? When? With What?

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Priya’s baby was born 8 weeks premature. For her entire pregnancy, she had been dreaming of the day she would breastfeed her baby, but now she was told that her breast milk alone may not be enough. This news went against everything she had heard about earlier. After all, she had been told by everyone that’s mother’s milk has all the nutrition a baby needs. She was told that she would need to give her baby fortified human milk.

What Happens if a Preemie Does Not Get Adequate Nutrition?

Babies born before 37 weeks of pregnancy are termed as premature babies. The third trimester is when babies gain weight and when their brain and lungs develop. Hence, they need extra care in their first few years and help to reach milestones at the same time as their full-term peers.

For example, if a preemie does not get adequate calcium and phosphorus, he/she may be at a higher risk of conditions like osteopenia. This is a condition wherein the bones have a lower density and a higher risk of fractures.

Thus, poor nutrition during early infancy can have implications that last for their entire lifetime.

When is Mother’s Milk Inadequate?

The milk produced by a mother depends on how far her pregnancy has progressed. The overall calorie count for preterm milk and full-term milk is the same; however, not all nutrient levels are the same.

In some cases, this may be good for the baby. For example, lower than normal sodium and protein levels in preterm milk means that the preemie will lose less water. This helps stabilize body temperature.

However in the case of babies born with low birth weight, i.e., a birth weight of less than 2500 grams, preterm breast milk may not be enough. The nutritional needs of a low-birth weight baby may be higher than what breast milk alone can provide.

This means that if your baby relies only on breast milk, he/she may not get the optimal nutrition required for their growth. Fortunately, there is a way out. Fortifying human milk adds to its nutritive value thereby fulfilling the baby’s nutritional needs.

Studies have shown that mother’s milk fortification can help with short-term and long-term improvements. It aids with the baby’s height gain, weight gain, and development of the head circumference. It can also improve neurological outcome and bone mineralization.

Human Milk Fortification

Human milk fortifiers can be described as powdered supplements that need to be added to breast milk before feeding the baby. They contain a mix of proteins, minerals, vitamins, and many other essential nutrients.

These fortifiers can be broadly classified depending on the type of milk used in their manufacturing. Traditionally, cow’s milk has been used extensively to prepare artificial feeds like infant formula and fortifiers. However, with recent advancements in technology and growing medical evidence on the benefits of exclusive human milk diets for newborns (especially premature babies), today, fortifiers exclusively derived from human milk are also available.

Using fortifiers made from cow’s milk may expose the tummies of vulnerable premature babies to animal protein. These are difficult to digest when compared to human milk and thus increase the risk of gastrointestinal complications. On the other hand, fortifiers made from human milk have been clinically demonstrated to help babies grow better with reduced risk of complications due to the presence of human milk proteins.

Feeding your Baby Fortified Breast Milk

The first step to feeding your baby fortified breast milk is to express breast milk in a clean sterile bottle. Mix the fortifier with the recommended quantity of breast milk. This fortified breast milk can then be fed to the baby. Do not add sugar, honey or any other ingredient to this fortified milk.

Do not change the recommended ratio of breast milk and fortifier without consulting the doctor.

Fortified breast milk should be consumed as early as possible, but not exceeding 8 hours when stored at approx. 26 degrees. Every effort should be made to ensure that the baby receives fresh feeds each time.

Takeaway

With the help of fortified milk, Priya’s baby soon grew stronger and achieved all developmental milestones to be at par with other babies of the same age.

Feeding your preemie fortified human milk keeps him/her healthy and also helps meet developmental milestones. There is no fixed timeline for the length of time a baby needs fortified milk. This depends on your baby’s age, overall health, weight and how well he/she can breastfeed.

Ultimately, this a clinical choice based on the baby’s growth and your doctor should always be consulted before your baby starts receiving fortified breast milk.

 

Reference Links:

https://www.summitmedicalgroup.com/library/pediatric_health/hhg_formula_instructions/

https://uichildrens.org/health-library/guidelines-use-human-milk-fortifier-neonatal-intensive-care-unit

https://breastfeeding.support/human-milk-fortifiers/

https://www.stanfordchildrens.org/en/topic/default?id=adding-to-mothers-milk-90-P02333


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