We had a recent brief discussion on Lactnet on the need for fortifier in donor milk.

Here’s a snippet from an open-access paper I’ve just come across in Nutrients 2010, though it may well be old news to others.  It is a proposal to study some unanswered milk banking questions like the risk of adding bovine fortifier, but look at the last line of the quote, which is discussing Lucas et al’s work in the 1980s.  Does anyone know if Lucas himself said this or if the current authors have extrapolated?   I’m surprised to see this in print, wondering why I haven’t come across the concept before.

“Infants who were fed preterm formula (protein: 2.0 g, energy: 80 kcal/100 mL) showed a 6-point advantage in MDI scores and a
14.7-point advantage in PDI scores compared to infants who were fed term formula (protein: 1.45 g,
energy: 68 kcal/100 mL) [9]. Interestingly, infants fed donor milk (protein: 1.1 g, energy:
50 kcal/100 mL) had similar outcomes compared to infants fed preterm formula, despite the low
nutrient content of donor milk compared to the preterm formula and to the estimated needs of
preterm infants [9]. Apparently, human milk contains an entity capable of making up for the low
nutrient content.”

www.mdpi.com/2072-6643/2/7/762/pdf
Human Milk Banking–Facts and Issues to Resolve
Willemijn E. Corpeleijn , Marijn J. Vermeulen , Ineke van Vliet , Caroline Kruger and Johannes B. van Goudoever.
Nutrients 2010, 2, 762-769; doi:10.3390/nu2070762

Why I think fortifier comes up regularly from IBCLCs who worked in poorer parts of Africa (and saw fortifier not being used, probably mostly because of economics) is that we are now more concerned about mixed feeding in the light of HIV transmission and the potential for gut damage.  The worry is even greater after the recent paper about fatty acids from formula digestion being cytoxic (with the potential to increase NEC) vs those from breast milk digestion (though I see from that paper that freezing milk below –20 degrees C can cause changes in fatty acids to make them more like those in artificial milk, argh!)

I realise that much in medicine has a trade-off between effect and side-effect, but I still believe that too little attention is paid to the risk of bovine fortifier in human milk. I certainly look forward to hearing more about the on-going study by Corpeleijn et al, above.

Best wishes
Jacquie Nutt IBCLC
Milk Matters
www.milkmatters.org 

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