Target fortification of breast milk: how often should milk analysis be done?

Niels Rochow, Gerhard Fusch, Bianca Zapanta, Anaam Ali, Sandip Barui, Christoph Fusch, Niels Rochow, Gerhard Fusch, Bianca Zapanta, Anaam Ali, Sandip Barui, Christoph Fusch

Abstract

Target fortification (TFO) reduces natural macronutrient variation in breast milk (BM). Daily BM analysis for TFO increases neonatal intensive care unit work load by 10-15 min/patient/day and may not be feasible in all nurseries. The variation of macronutrient intake when BM analysis is done for various schedules was studied. In an observational study, we analyzed 21 subsequent samples of native 24-h BM batches, which had been prepared for 10 healthy infants (gestational age 26.1 ± 1.3 weeks, birth weight: 890 ± 210 g). Levels of protein and fat (validated near-infrared milk analyzer), as well as lactose (UPLC-MS/MS) generated the database for modelling TFO to meet recommendations of European Society for Paediatric Gastroenterology Hepatology and Nutrition. Intake of macronutrients and energy were calculated for different schedules of BM measurements for TFO (n = 1/week; n = 2/week; n = 3/week; n = 5/week; n = 7/week) and compared to native and fixed dose fortified BM. Day-to-day variation of macronutrients (protein 20%, carbohydrate 13%, fat 17%, energy 10%) decreased as the frequency of milk analysis increased and was almost zero for protein and carbohydrate with daily measurements. Measurements two/week led to mean macronutrient intake within a range of ± 5% of targeted levels. A reduced schedule for macronutrient measurement may increase the practical use of TFO. To what extent the day-to-day variation affects growth while mean intake is stable needs to be studied.

Figures

Figure 1
Figure 1
Variation of macronutrient and energy content in target fortified breast milk (BM) for different frequencies of measurements compared with native BM and fixed dose fortified (FDF) BM. The first boxplot of each group represents all samples (n = 210), followed by ten boxplots with data (n = 21) for individual subjects.
Figure 2
Figure 2
Percentage of samples with the deviation of macronutrients and energy content from ESPHGAN recommendations in single breast milk (BM) batches for native BM, fixed dose fortification (FDF) and target fortification (TFO) (five different schedules). The X-axis shows stratified ranges (deviation from target levels). The sum of relative frequencies per schedule is 100%.

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Source: PubMed

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