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Subject:
From:
Sara Bernard <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 27 Nov 2001 21:53:45 +0100
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With regard to the recent discussion about mixing mothersmilk with formula.
I had a look at this topic for someone else a few days ago and found many
references relating to fortification of human milk for preterm or LBW
infants. Although this situation is different from mixing formual with human
milk there might be some parallels, especially relating to the osmolarity
and the effect of human milk amylase on the formula.

Hope this can be some help to someone?
Of course the advice given by Pat Gima is the most obvious ("But I do
recommend that mom give baby the breastmilk separate from the formula
because of waste of the great stuff if baby doesn't drink all of the
bottle.")

Sara Bernard
The Netherlands

Effect of fortification on the osmolality of human milk
 http://adc.bmjjournals.com/cgi/content/full/fetalneonatal%3b81/2/F141

Pediatrics 1997 Aug;100(2 Pt 1):240-3
The effects of nutrient fortification and varying storage conditions on host
defense properties of human milk.
Jocson MA, Mason EO, Schanler RJ.
USDA/ARS Children's Nutrition Research Center, Department of Pediatrics,
Baylor College of Medicine, and Texas Children's Hospital, Houston, Texas
77030, USA.
OBJECTIVE: Data are scarce regarding the effects of nutrient fortification
and storage on the immunoprotective properties of human milk. These effects
are important considerations when feeding premature infants. We hypothesized
that total bacterial colony counts (TBCC) and immunoglobulin A (IgA)
concentration were not affected by the addition of fortifier even when
tested under extreme storage conditions and that osmolality of fortified
human milk does not increase with storage. METHODS: Ten frozen and five
fresh milk samples from mothers of premature infants were divided into
fortified and unfortified milk, and stored for 72 hours at either
refrigerator or room temperature. Aliquots were obtained at 0 to 72 hours
for TBCC, osmolality, and total IgA, and analyzed by repeated measures
analysis of variance (ANOVA). RESULTS: Log10 TBCC in milk stored at
refrigerator temperature for 0, 24, 48, and 72 hours were significantly
greater in fortified vs unfortified milk; both increased similarly with
storage. Osmolality was greater in fortified than unfortified milk; both
increased by approximately 4% with storage. IgA concentration was not
affected by fortification or storage. To simulate the usual nursery use of
fortified human milk, a separate evaluation was performed. Fortified milk
was stored at refrigerator temperature for 20 hours, warmed in a 40 degrees
C laboratory incubator for 20 minutes, and placed in a 34 degrees C infant
incubator for 4 hours. Samples for TBCC were obtained at 0, 20, and 24 hours
and analyzed by repeated measures ANOVA. Log10 TBCC in fortified,
refrigerated milk did not change over the 20-hour storage but increased
during the simulated 4-hour usage. CONCLUSIONS: These findings may warrant
consideration when using human milk in the neonatal nursery but support
recommendations to use commercially fortified human milk within 24 hours.

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