Human Milk Analysis Contributes to Nutritional Management of Very Low Birth Weight Infants

Blake B. Sparks, BSN, Paula G. Radmacher, MSPH, PhD, Salisa L. Lewis, MS, RD, Laura A. Serke, RD, LD, CLC, David H. Adamkin, MD, Childhood Obesity and Nutrition, Vol 6, Issue 5, pp. 295 - 300, First published date: July-22-2014 10.1177/1941406414543493

OBJECTIVE
To evaluate the contribution of real-time human milk (HM) analysis in the development of individual fortification plans for very low birth weight (VLBW) infants (<1500 g).

METHODS
Pooled, 24-hour samples of HM were analyzed 1 to 2 times weekly. HM was fortified using 30 kcal/oz preterm formula (PTF) or acidified concentrated liquid formula (ACLF). Daily nutrient intakes, growth, and laboratory data were collected from the week prior to fortification and for the 4 weeks of the study period. Protein (g/kg/day) and energy (kcal/ kg/day) intakes were calculated by adding the proportional contributions from HM and fortifier.

RESULTS 
There were 24 VLBW infants. Both groups (PTF, n = 18; ACLF, n = 6) had similar birth characteristics. HM protein and energy content varied considerably throughout the study. Mean protein intake was significantly higher in infants receiving ACLF (P < 0.001) compared to PTF, while energy intake was similar. The proportion of HM used with ACLF was significantly higher than with PTF (P < 0.001). Mean blood urea nitrogen decreased by about half from prefortifier to week 1 in both groups, although levels were lower in PTF than ACLF infants.

CONCLUTION 
Real-time HM analysis and individualized fortification strategies are an effective means of improving protein and energy intakes in VLBW infants.