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SUMMARY
Various methods have been reported and used clinically to augment
the nutrient supply for humman milk-fed premature infants. These
methods include specialized multinutrient powdered mixtures
(fortifiers ), complete liquid formulas designed to be mixed with
human milk, complete powdered formulas to be mixed with human milk,
and alternate feeding of human milk and preterm formula. Although
the optimum nutrition of premature infants is unknown, data are
acculating to suggest that human milk, fortified with additional
nutrients, is appropriate for tube-fed infants. The use of fortified
human milk typically provides premature infants sdequate growth,
nutrient retention, and biochemical indices of nutritional status
when fed at approximately 180mL/kg/d compared with unfortified human
milk. Data are needed to determine the precise quanitity of
nutrients to be added as supplements.
Nutrient interactions have not been explored in detail. Although
large quantities of calcium seem to be needed, the exogenous calcium
may affect far absorption adversely. Manipulation of milk may affect
the intrinsic host-defense properties of the milk. Compared with
preterm formula, the feeding of fortified human milk may provide
significant protection from infection and NEC. Lastly, the potential
stimulation of an enteromammary pathway through skin-to-skin contact
provides species-specific antimicrobial protection for premature
infants. Several of these areas require additional exploration .
Thus , for premature infants, neonatal centers should encourage the
feeding of fortified human milk, together with skin-to-skin contact,
as reasonable methods to enhance milk production while potentially
facilitating the development of an enterommary response.
(The Pediatric Clinic of North America)
BREASTFEEDING 2001, PART I:
THE EVIDENCE FOR BREASTFEEDING
Volume 48.Number1.February 2001
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