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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