Homologous fortification of human milk for the preterm very low birth weight infant in developing countries
Creators: name: Valentini, Fabio Sergio
Publisher: name: University of British Columbia
Year: 2009

description: Human milk is considered as the gold standard for infant nutrition. However, preterm, term, and banked human milk is not nutritionally adequate for the high nutrient requirements of the small premature infant. To meet the nutritional needs of the preterm infant, the nutrient content of human milk needs to be increased. Several studies have been conducted using human milk components as supplements (homologous fortification), and these studies have shown that the rate of weight gain of the premature infants fed fortified human milk approximated intrauterine growth rate. However, the expense associated with this technology limits its practical use, especially in developing countries where finances allocated to the care of the preterm infants are limited and often do not allow for the purchase of such fortifiers. One of the objectives of this study was to assess the feasibility of a simple and inexpensive technique of human milk concentration described by Martinez (1989). Another objective was the preparation of a homologous human milk fortifier using the concentrated human milk. The final objective was to assess the potential nutritional adequacy of the prepared fortified human milk by comparing its nutrient content with the nutrient requirements of the preterm very low birth weight infant. Sixteen donor milk (dHM) samples were concentrated (evaporation and subsequent lactose removal) under vacuum using a rotary evaporator. The concentrated human milk (cHM) obtained had a significantly higher nutrient content (p&lt;0.001) compared to that of dHM. Protein, fat, and lactose content of cHM increased 2.94±0.67, 2.35±0.79, and 2.36±0.33 times, respectively compared to dHM. Calcium, phosphorus, and sodium content of c HM increased 3.69±0.69, 3.67±0.84, and 2.09±0.47 times, respectively compared to dHM. The c HM obtained was then used to fortify dHM resulting in the production of a fortified human milk (fHM). Three different types of fHM ("low", "medium", and "high") were prepared by mixing dHM and c HM at different proportions. The protein content of the fHM preparations was significantly higher than that of dHM (p&lt;0.05). Fat content of the fHM preparations was not significantly different from dHM, with the exception of "high" fHM (p&lt;0.05). Calcium and phosphorus content of the fHM preparations was significantly higher than that of dHM (p&lt;0.001). Only the "medium" and the "high" fHM had a significantly higher sodium content (p&lt;0.001). The osmolality of the fHM increased markedly and was significantly higher in the fHM preparations compared to dHM (p&lt;0.001). The energy content of the fHM preparations was not significantly different from dHM, except for the "high" fHM (p&lt;0.05). Overall, the nutrient content of the fHM preparations was higher than that of dHM. In conclusion, the concentration and homologous fortification of human milk using a simple and inexpensive technique was achieved. However, the increment of the nutrients determined in the cHM showed a high degree of variability. In spite of the increased concentration of nutrients in the fHM, protein, calcium and phosphorus levels may still not meet the requirement of the preterm very low birth weight infant