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118 Controversies in Breast Milk Fortification
  1. G Zachariassen
  1. HC Andersen Childrens’ Hospital, Odense, Denmark


Inadequate nutrition has been associated with impaired brain development among preterm infants. Especially low protein intake has been proven to be the primary limiting factor responsible for growth failure among preterm infants during the first critical week(s) after birth. In order to recover or catch-up after these first weeks, feeding has to replace both the deficit accumulated and to meet the requirements for normal growth.

Human milk (HM) has many advantages in the nutrition of preterm infants. Protein-concentration in HM is though variable and decreases with the duration of breastfeeding.

Fortification of HM with a multicomponent fortifier makes it possible to increase the concentration of nutrients - especially protein to meet the nutritional requirements of the preterm infants.

Fortification of HM can be achieved by standard fortification or individualized fortification. With individualized target fortification, the fortification method is based on HM analyses, adding protein to reach the targeted intake.

Fortified HM is easily fed as long as the preterm infant has a nasogastric tube during hospitalization. After hospital discharge fortification of HM becomes a challenge, but can be established using a bottle with fortified HM as supplementation while breastfeeding.

Among “healthy” preterm infants catch-up growth can be achieved before discharge, while “sick” and small for gestational age preterm infants might not achieve catch-up growth until months or years after discharge. A gradual return to normal for all growth variables while avoiding excessive weight gain should be the goal for nutrition of very preterm infants during and after hospital discharge.

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