Do I need to fortify my preemie’s milk

In the delicate world of premature babies, every ounce of care and nutrition matters profoundly. For mothers of preemies who choose to breastfeed, human milk fortification emerges as a vital intervention that can significantly impact the health and development of their fragile infants.

Breast milk is undoubtedly the gold standard for infant nutrition, offering a unique blend of nutrients, antibodies, and growth factors that promote optimal growth and immunity. However, many families with preterm infants typically 31-33 weekers) may be told their breast milk isn’t nutritionally adequate and they either need to supplement baby with formula or a human milk fortifier. It’s not that your milk is inadequate, it’s that babies born early miss out on a surge of nutrient absorption that normally would have occurred during the third trimester. Preemies have higher nutrient requirements, especially for protein, minerals like calcium and phosphorus, and certain vitamins like vitamin D. They should have been getting these nutrients from your placenta which takes these nutrients from your blood and bones. A preemie’s gastrointestinal tract is also very immature, less efficient at processing nutrients and more prone to distress. Preemies who experience medical complications including infection, respiratory disorders, surgeries, and stress, experience an increase in metabolism and increased caloric demand. So babies born prematurely have multiple reasons for needing more nutrients than an otherwise healthy full-term baby. Human milk fortifiers are designed to supplement breast milk with these essential nutrients to match the specific needs of premature infants, supporting their growth and development, that they missed.

Currently there are two main types of human milk fortifier available. The first is made using cow-based protein. It comes as either a powder or liquid which get added to pumped breast milk. The second fortifier is actually made of donated human milk from other pumping mothers. The only manufacturer of human based fortifier in the US currently is Prolacta Bioscience, and is only available to hospitals. Donated milk is modified into a frozen liquid concentrate which is added to pumped milk in the NICU.

Premature infants often struggle with catching up to the growth milestones of full-term babies. Fortifying breast milk helps enhance calorie intake and nutrient absorption, aiding in weight gain and promoting more rapid growth without increasing the volume of milk intake.

Preterm infants are at increased risk of various health complications, including necrotizing enterocolitis (NEC) and developmental delays. Fortified breast milk has been shown to lower the incidence of NEC and other serious conditions by providing a more robust nutritional profile.

Adequate nutrition during the neonatal period is critical for preventing long-term health problems such as neurodevelopmental impairments and metabolic disorders. Fortifying breast milk ensures that preemies receive the essential nutrients necessary for optimal brain and organ development.

Human milk fortification enables mothers to continue breastfeeding while meeting their preemie's unique nutritional needs. This approach supports the emotional and physiological benefits of breastfeeding while addressing the challenges posed by premature birth.

How long after birth they need to be supplemented depends upon many factors, including baby’s gestational age at birth, medical condition, nutritional status, and the individual practices of the NICU team your baby worked with. It’s very common for NICU graduates to require special nutrients for weeks to months after going home. This might be as simple as adding small amounts of over-the-counter preemie formula to pumped milk, adding in a few bottles of preemie formula each day, or as complex as using specialized prescription formulas. 

Ultimately, human milk fortification represents a critical component of neonatal care for premature infants. It empowers mothers to provide the best nutrition possible for their preemies, supporting their babies' health and development during this vulnerable stage of life. Healthcare providers play a pivotal role in guiding mothers through the process of human milk fortification, offering education and support to optimize outcomes for these tiny fighters.

By recognizing the importance of fortifying breast milk for preemie babies, we can enhance the quality of care and improve the long-term health prospects of these resilient little ones. Every drop of fortified breast milk signifies a step forward in nurturing and protecting the smallest members of our communities.

The composition of breast milk undergoes significant changes to meet the evolving nutritional needs of infants as they grow. The differences between preterm (colostrum and transitional milk) and mature breast milk are particularly important for understanding how mothers can support the unique requirements of preterm babies. Here's a breakdown of these differences:

**1. Protein Content:**

   - Preterm Breast Milk: Higher in protein, specifically whey protein, which is easier for preterm infants to digest.

   - Mature Breast Milk: Lower in total protein compared to preterm milk, with a higher proportion of casein protein.

**2. Fat Composition:**

   - Preterm Breast Milk: Contains more medium-chain fatty acids and higher levels of essential fatty acids like DHA (docosahexaenoic acid) and ARA (arachidonic acid), which are crucial for brain and visual development.

   - Mature Breast Milk: Higher in long-chain fatty acids, reflecting the changing needs of the growing infant.

**3. Carbohydrates:**

   - Preterm Breast Milk: Contains higher levels of lactose and oligosaccharides, providing readily available energy for the developing preterm baby.

   - Mature Breast Milk: Still rich in lactose but with a slightly lower concentration compared to preterm milk.

**4. Minerals and Vitamins:**

   - Preterm Breast Milk: Generally higher concentrations of certain minerals like calcium, phosphorus, and zinc to support bone and overall growth.

   - Mature Breast Milk: Adequate levels of minerals and vitamins tailored to the needs of a growing infant.

**5. Immunological Factors:**

   - Preterm Breast Milk: Richer in immunoglobulins (especially secretory IgA) and other immune factors to bolster the preterm baby's immature immune system and protect against infections.

   - Mature Breast Milk: Continues to provide valuable immunological support but at levels adjusted for the older infant's immune needs.

**6. Growth Factors:**

   - Preterm Breast Milk: Higher levels of growth factors like insulin-like growth factor (IGF) to support rapid growth and development.

   - Mature Breast Milk: Contains growth factors in appropriate proportions to sustain healthy growth without promoting excessive weight gain.

**7. Micronutrients:**

   - Preterm Breast Milk: Often supplemented with higher levels of vitamins and minerals to meet the increased requirements of preterm infants.

   - Mature Breast Milk: Provides sufficient micronutrients for the needs of older infants, although additional supplementation may be necessary depending on the infant's diet.

Understanding these differences underscores the importance of tailored nutrition for preterm infants. While human milk is always beneficial, preterm breast milk offers a specialized blend of nutrients and bioactive components uniquely suited to support the growth and development of premature babies during the critical early stages of life. As preterm infants transition to mature breast milk, the composition adjusts to meet their changing nutritional demands, ensuring optimal health and development as they continue to thrive on mother's milk.