319
Journal of Neonatal-Perinatal Medicine 6 (2013) 319–323 DOI 10.3233/NPM-1373113 IOS Press
Original Research
Individualizing fortification of human milk using real time human milk analysis P.G. Radmachera,∗ , S.L. Lewisb and D.H. Adamkina a Department b Neonatal
of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA Intensive Care Unit, Kosair Children’s Hospital, Louisville, KY, USA
Received 07 June 2013 Revised 13 September 2013 Accepted 27 September 2013
Abstract. OBJECTIVE: To use real-time human milk macronutrient analysis to calculate final composition following fortification. STUDY DESIGN: Preterm HM (PHM) and pooled donor human milks (DHM) were analyzed by mid-infrared spectroscopy for protein, fat and lactose. Energy content was calculated from macronutrient results. Three lactation stages were constructed. DHM was compared to PHM. Four milk sample profiles were selected to demonstrate individualized fortification results. RESULTS: Lactose was similar in PHM and DHM. Protein in PHM showed the expected decline as lactation progressed. DHM protein was significantly lower vs. PHM. Fat was highly variable and lowest in DHM. Using standard fortification protocols, not all fortified milks met targets for protein and energy. Individualized fortification resulted in milks closer to target recommendations. CONCLUSIONS: Real-time analysis of HM provides assessment of the macronutrient content of the milk and can guide fortification. Individualized protocols, based on actual milk macronutrient profiles, may need to be considered to avoid unexpected nutrient content. Keywords: Human milk analysis, human milk fortification
1. Introduction Human milk (HM) is the preferred feeding for human infants, including those born preterm [1–6]. While the milk from a woman delivering very prematurely has some nutritional limitations [7–10], the immunological and many other benefits of human milk, are very important for the overall health of the infant [11–14]. Human milk is a complex biological fluid composed of thousands of compounds which vary from woman to ∗ Corresponding
author: Dr. Paula G. Radmacher, Neonatal Nutrition Research Laboratory, 511S. Floyd St. Room 107, University of Louisville, Louisville, KY 40292, USA. Tel.: +1 502 852 5532; Fax: +1 502 852 8826; E-mail: [email protected].
woman, within a feeding, a day and over the entire lactation period [7, 8, 15–18]. The nutrient profile and volume of milk produced on any given day can be influenced by a number of factors, including maternal nutritional status, parity, gestation at delivery, and stage of lactation [17]. The time of day, length and method of expression (mechanical pump, hand expression), volume of milk expressed and method of storage all impact the profile. The macronutrient content of HM has been studied in women from various cultures and with different types of diets [7, 14, 19–24]. The concentration of important nutrients such as Vitamin D can be affected by diet and geography [25] while others, such as Vitamins C and K are not dependent on maternal dietary intake [17, 26, 27]. While HM is sufficient
1934-5798/13/$27.50 © 2013 – IOS Press and the authors. All rights reserved
320
P.G. Radmacher et al. / Real-time human milk macronutrient analysis
to support the growth and development of the normal term infant, preterm human milk (PHM) may be inadequate to meet the nutrient requirements of the very low birth weight infant (
Journal of Neonatal-Perinatal Medicine 6 (2013) 319–323 DOI 10.3233/NPM-1373113 IOS Press
Original Research
Individualizing fortification of human milk using real time human milk analysis P.G. Radmachera,∗ , S.L. Lewisb and D.H. Adamkina a Department b Neonatal
of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA Intensive Care Unit, Kosair Children’s Hospital, Louisville, KY, USA
Received 07 June 2013 Revised 13 September 2013 Accepted 27 September 2013
Abstract. OBJECTIVE: To use real-time human milk macronutrient analysis to calculate final composition following fortification. STUDY DESIGN: Preterm HM (PHM) and pooled donor human milks (DHM) were analyzed by mid-infrared spectroscopy for protein, fat and lactose. Energy content was calculated from macronutrient results. Three lactation stages were constructed. DHM was compared to PHM. Four milk sample profiles were selected to demonstrate individualized fortification results. RESULTS: Lactose was similar in PHM and DHM. Protein in PHM showed the expected decline as lactation progressed. DHM protein was significantly lower vs. PHM. Fat was highly variable and lowest in DHM. Using standard fortification protocols, not all fortified milks met targets for protein and energy. Individualized fortification resulted in milks closer to target recommendations. CONCLUSIONS: Real-time analysis of HM provides assessment of the macronutrient content of the milk and can guide fortification. Individualized protocols, based on actual milk macronutrient profiles, may need to be considered to avoid unexpected nutrient content. Keywords: Human milk analysis, human milk fortification
1. Introduction Human milk (HM) is the preferred feeding for human infants, including those born preterm [1–6]. While the milk from a woman delivering very prematurely has some nutritional limitations [7–10], the immunological and many other benefits of human milk, are very important for the overall health of the infant [11–14]. Human milk is a complex biological fluid composed of thousands of compounds which vary from woman to ∗ Corresponding
author: Dr. Paula G. Radmacher, Neonatal Nutrition Research Laboratory, 511S. Floyd St. Room 107, University of Louisville, Louisville, KY 40292, USA. Tel.: +1 502 852 5532; Fax: +1 502 852 8826; E-mail: [email protected].
woman, within a feeding, a day and over the entire lactation period [7, 8, 15–18]. The nutrient profile and volume of milk produced on any given day can be influenced by a number of factors, including maternal nutritional status, parity, gestation at delivery, and stage of lactation [17]. The time of day, length and method of expression (mechanical pump, hand expression), volume of milk expressed and method of storage all impact the profile. The macronutrient content of HM has been studied in women from various cultures and with different types of diets [7, 14, 19–24]. The concentration of important nutrients such as Vitamin D can be affected by diet and geography [25] while others, such as Vitamins C and K are not dependent on maternal dietary intake [17, 26, 27]. While HM is sufficient
1934-5798/13/$27.50 © 2013 – IOS Press and the authors. All rights reserved
320
P.G. Radmacher et al. / Real-time human milk macronutrient analysis
to support the growth and development of the normal term infant, preterm human milk (PHM) may be inadequate to meet the nutrient requirements of the very low birth weight infant (
