Mother’s milk is the First Choice for Feeding Preterm Infants

Mother’s milk is the First Choice for Feeding Preterm Infants

Human milk is biologically, clinically and nutritionally most effective feeding mode for preterm infants

Nutrition Remarks Health News Highlights (July 25, 2013)

Written by Deeksha Sharma, Ph.D., Health News Writer for Nutrition Remarks, Solon, OH, USA

Reviewed by Dr. Bertino Enrico Neonatal Unit, University of Turin, Italy

Breastfeeding is identified as the normative standard for infant feeding and nutrition. However, human milk (HM) should be fortified to ensure optimal nutrient intake in preterm Very Low Birth Weight (VLBW) infants. Considering the short and long-term clinical, metabolic, immunologic and neurodevelopmental advantages of breastfeeding, individualized and adjustable fortification of HM is found most effective for these infants.

Growing evidence supports use of human milk for sick and preterm infants in Neonatal Intensive Care Units (NICUs). Human milk is composed of bioactive and immunomodulatory factors that modulate the immune response and modify intestinal bacterial flora, while ensuring adequate host defense against infections.  The presence of bioactive and immunomodulatory factors such as Human Milk Oligosaccharides (HMOs), Glycosaminoglycans (GAGs), Immunoglobulin A (IgA) and its low lactose concentration highlights the importance of breastfeeding  preterm infants, who are  at greater risk of developing infections.

Necrotizing Enterocolitis (NEC) is a life-threatening condition that affects the large intestine of preterm babies. Infants fed with HM have shown to reduce the incidence of NEC. Furthermore, early enteral feeding with HM also significantly reduces the risk of late onset sepsis. Research also indicates that  HM also improves clinical feeding tolerance and attainment of early and total enteral feeding  in VLBW preterm infants.

Though, HM is the optimal feeding choice, it needs fortification to meet nutritional requirements of preterm infants, where low protein intake often results in growth failure. Individual fortification of HM is useful for VLBW infants in order to compensate high variability of expressed breast milk composition. Individual fortification of HM is achieved through either adjustable- or targeted- fortification. The targeted fortification analyze HM and fortify it in a way that infant always receive same amount of nutrients. However, adjustable fortification is based on infant’s metabolic response and safeguards infants against excessive protein intakes. Long-term studies of preterm infants suggest that HM feeding is associated with lower rates of metabolic syndrome, reduced risk of hypertension and low-density lipoprotein (LDL) concentrations in adolescence.

Further, neurodevelopmental outcome of preterm infants is improved by feeding with HM. Long-term studies suggest that white matter and total brain volumes are greater in subjects who received HM in NICU. Extremely preterm infants who received greatest proportion of HM in NICU had significantly greater scores for mental, motor, and behavior ratings at ages 18 months and 30 months. Breastfeeding creates a greater emotional involvement and a sense of gratification in mothers as well. Therefore, benefits of breastfeeding outweigh purely nutritional aspects of it and can be considered part of Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

American Academy of Pediatrics in its policy statement on breastfeeding recommends that pasteurized Donor Milk (DM), appropriately fortified, should be used for preterm infants if mother’s own milk is unavailable or its use is contraindicated. Donor milk banks are not only meant to collect, process and store donated milk, but they also represent an instrument for breastfeeding promotion and support. Though, analysis of costs and an evaluation of acceptability are required while exploring different cultural, religious and social attitudes to DM.

Besides meeting immediate nutritional needs, early nutrition has potentially long-lasting or lifelong biological effects through metabolic “programming” of infant. Authors suggest that to achieve growth potential in preterm VLBW infants with good health and neurological development, breastfeeding and use of human milk are the best tools.

This news highlight is based on the following article published by Bertino E et al. Additional general background information was acquired from PubMed.

Bertino E, et al. Biological, nutritional and clinical aspects of feeding preterm infants with human milk. J Biol Regul Homeost Agents. 2012 Jul-Sep;26(3 Suppl):9-13.