Laura,

I reviewed much of the research on fortifiers for premies for my book 
Breastfeeding Answers Made Simple (Hale Publishing, 2010).  Below are 
some excerpts from BAMS with the references.  I'm not sure there is 
agreement on the specifics you are looking for, but perhaps this will help.

Warm regards,
Nancy Mohrbacher, IBCLC, FILCA, LLLL, BfUSA BC
Chicago suburbs
www.nancymohrbacher.com

A Cochrane Review concluded that adding fortification to mother’s milk 
increased short-term weight gain and body growth, but found no long-term 
benefits (Kuschel & Harding, 2004).Another Canadian meta-analysis noted 
that although preemies receiving fortified human milk grew faster, “this 
benefit could not be weighted against the adverse consequences of 
elevated blood urea nitrogen levels and increased metabolic acidosis and 
neurodevelopmental abnormalities” (Premji, Fenton, & Sauve, 2006).A 
Swedish study found that although the babies who received fortifiers 
grew faster, there was also more illness in the fortified group and that 
exclusive breastfeeding led to later improvement in growth (Funkquist, 
Tuvemo, Jonsson, Serenius, & Hedberg-Nyqvist, 2006).

Rather than giving every preterm baby of the same gestational age and 
weight the same amount of standard fortifier, researchers are examining 
how fortification can be tailored to the individual needs of each 
preemie.One U.S. study found that weight gain and growth were 
significantly better in preemies who received fortification adjusted to 
their nutritional needs (based on blood tests) rather than standard 
fortification (Arslanoglu, Moro, & Ziegler, 2006).To better provide the 
nutrients the preterm baby needs, in several countries both mother’s 
milk and donor milk are analyzed routinely for protein, carbohydrates, 
and fat content (Polberger & Lonnerdal, 1993).A Japanese study recently 
tested a machine designed to be used at the bedside to analyze the 
nutritional content of mother’s milk, which could help tailor 
fortification (Menjo et al., 2009).As these advances become commercially 
available, customizing mother’s milk fortification may lead to better 
health outcomes.

References

Arslanoglu, S., Moro, G. E., & Ziegler, E. E. (2006). Adjustable 
fortification of human milk fed to preterm infants: does it make a 
difference? /J Perinatol, 26/(10), 614-621.

Funkquist, E. L., Tuvemo, T., Jonsson, B., Serenius, F., & 
Hedberg-Nyqvist, K. (2006). Growth and breastfeeding among low birth 
weight infants fed with or without protein enrichment of human milk. 
/Ups J Med Sci, 111/(1), 97-108.

Kuschel, C. A., & Harding, J. E. (2004). Multicomponent fortified human 
milk for promoting growth in preterm infants. /Cochrane Database of 
Systematic Reviews, 1/, CD000343.

Menjo, A., Mizuno, K., Murase, M., Nishida, Y., Taki, M., Itabashi, K., 
et al. (2009). Bedside analysis of human milk for adjustable nutrition 
strategy. /Acta Paediatr, 98/(2), 380-384.

Polberger, S., & Lonnerdal, B. (1993). Simple and rapid macronutrient 
analysis of human milk for individualized fortification: basis for 
improved nutritional management of very-low-birth-weight infants? /J 
Pediatr Gastroenterol Nutr, 17/(3), 283-290.

Premji, S., Fenton, T., & Sauve, R. (2006). Does Amount of Protein in 
Formula Matter for Low-Birthweight Infants? A Cochrane Systematic 
Review. /JPEN J Parenter Enteral Nutr, 30/(6), 507-514.



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