TY - GEN
T1 - Mother’s own milk and fortification for very preterm infants
AU - Bendix Simonsen, Marie
PY - 2024/6/18
Y1 - 2024/6/18
N2 - Very preterm infants (VPI), born before the 32nd week of gestation, have high nutritional
requirements due to low body stores at birth, immature intestines, and impeding proper nutrient
absorption possibly predisposing them to nutritional deficiencies. Mother’s own milk (MOM) is the
preferred nutrition for VPI due to its unique nutritional composition and bioactive cells, especially
abundant in colostrum, promoting gut and brain maturation while protecting against infections.
However, delayed maternal milk production often necessitates the use of donor human milk (DHM)
immediately after birth, which contains fewer bioactive cells compared to MOM and differs in
energy composition. However, neither MOM nor DHM provides sufficient protein and minerals for
preterm infants, which is why fortifiers are added to the human milk. Yet, recent studies indicate
that even fortified human milk fails to meet recommended mineral intake, with mineral content
varying significantly among products.In our first study, we investigated mineral status among VPI fed a bovine colostrum-based fortifier
compared to a well-known conventional fortifier used in all Danish neonatal units. Blood
biochemistry for calcium, phosphate, and hemoglobin was assessed before and up to three weeks
after the start of fortification. Maximum doses of supplemental calcium, phosphate, and iron were
retrieved from patient medical records. We found that the blood biochemistry was similar between
the two groups. Surprisingly, infants in both groups required additional calcium and phosphate.
However, infants fed bovine colostrum required even higher doses (p<0.05) to maintain acceptable
blood biochemistry. Regardless of fortification groups, we found that the most immature (<29
weeks of gestation) and/or small for gestational age infants had a higher risk of requiring additional
phosphate.In the second study, we aimed to map the evidence behind the variations in the content of minerals
in fortification products for VPI. The review encompasses a comprehensive search strategy across
relevant databases (MEDLINE, Embase, Scopus, and Cochrane). Furthermore, we contacted the
companies that produce fortification products, by email to identify any clinical study reports or
other relevant papers conducted by the companies. We identified 8012 studies through a database
search and included twelve of those in the review after screening of title and abstract and full text,
respectively. We identified no further relevant studies following the request to the companies. The
twelve studies were very diverse in methodology and outcome, with only three of them having a
primary aim of evaluating mineral status. Eight of the twelve studies reported procedures for
additional minerals, but only two studies reported actual additional doses given. Well-designed studies are needed to investigate mineral absorption from fortification products and the optimal
composition of fortification products.
Previous studies have demonstrated that antenatal breastmilk expression (aBME) can make MOM
available immediately after birth. However, it has never been investigated before the 37th week of
pregnancy (term) due to concerns that it might induce contractions and thereby preterm labor. We
aimed to investigate aBME before term age, by conducting a randomized controlled trial, starting
from the 34th week of pregnancy. No one has ever done this type of study before term age. Healthy
nulliparous women were randomly assigned to either hand expression of the breast from the 34th
week of pregnancy or assigned to a control group. We found no difference in gestational age at birth
between the groups. Most women were able to collect milk during pregnancy in varying amounts,
and we found no difference in the number of women who were breastfeeding their infants
subsequently. Antenatal breastmilk expression is safe before term in healthy women from week 34
of pregnancy, and MOM can be available for the infant immediately after birth. This can have
significant positive clinical implications for preterm infants if aBME is applicable in high-risk
pregnancies at earlier stages of pregnancy.
AB - Very preterm infants (VPI), born before the 32nd week of gestation, have high nutritional
requirements due to low body stores at birth, immature intestines, and impeding proper nutrient
absorption possibly predisposing them to nutritional deficiencies. Mother’s own milk (MOM) is the
preferred nutrition for VPI due to its unique nutritional composition and bioactive cells, especially
abundant in colostrum, promoting gut and brain maturation while protecting against infections.
However, delayed maternal milk production often necessitates the use of donor human milk (DHM)
immediately after birth, which contains fewer bioactive cells compared to MOM and differs in
energy composition. However, neither MOM nor DHM provides sufficient protein and minerals for
preterm infants, which is why fortifiers are added to the human milk. Yet, recent studies indicate
that even fortified human milk fails to meet recommended mineral intake, with mineral content
varying significantly among products.In our first study, we investigated mineral status among VPI fed a bovine colostrum-based fortifier
compared to a well-known conventional fortifier used in all Danish neonatal units. Blood
biochemistry for calcium, phosphate, and hemoglobin was assessed before and up to three weeks
after the start of fortification. Maximum doses of supplemental calcium, phosphate, and iron were
retrieved from patient medical records. We found that the blood biochemistry was similar between
the two groups. Surprisingly, infants in both groups required additional calcium and phosphate.
However, infants fed bovine colostrum required even higher doses (p<0.05) to maintain acceptable
blood biochemistry. Regardless of fortification groups, we found that the most immature (<29
weeks of gestation) and/or small for gestational age infants had a higher risk of requiring additional
phosphate.In the second study, we aimed to map the evidence behind the variations in the content of minerals
in fortification products for VPI. The review encompasses a comprehensive search strategy across
relevant databases (MEDLINE, Embase, Scopus, and Cochrane). Furthermore, we contacted the
companies that produce fortification products, by email to identify any clinical study reports or
other relevant papers conducted by the companies. We identified 8012 studies through a database
search and included twelve of those in the review after screening of title and abstract and full text,
respectively. We identified no further relevant studies following the request to the companies. The
twelve studies were very diverse in methodology and outcome, with only three of them having a
primary aim of evaluating mineral status. Eight of the twelve studies reported procedures for
additional minerals, but only two studies reported actual additional doses given. Well-designed studies are needed to investigate mineral absorption from fortification products and the optimal
composition of fortification products.
Previous studies have demonstrated that antenatal breastmilk expression (aBME) can make MOM
available immediately after birth. However, it has never been investigated before the 37th week of
pregnancy (term) due to concerns that it might induce contractions and thereby preterm labor. We
aimed to investigate aBME before term age, by conducting a randomized controlled trial, starting
from the 34th week of pregnancy. No one has ever done this type of study before term age. Healthy
nulliparous women were randomly assigned to either hand expression of the breast from the 34th
week of pregnancy or assigned to a control group. We found no difference in gestational age at birth
between the groups. Most women were able to collect milk during pregnancy in varying amounts,
and we found no difference in the number of women who were breastfeeding their infants
subsequently. Antenatal breastmilk expression is safe before term in healthy women from week 34
of pregnancy, and MOM can be available for the infant immediately after birth. This can have
significant positive clinical implications for preterm infants if aBME is applicable in high-risk
pregnancies at earlier stages of pregnancy.
U2 - 10.21996/e1hf-f025
DO - 10.21996/e1hf-f025
M3 - Ph.D. thesis
PB - Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
ER -