Background TFO of breast milk (BM) overcomes the uncertainty of macronutrient intake in fixed dose fortification (FDF) resulting from natural variation in breast milk and improves growth of VLBW infants.
Objective To study variation of macronutrient intake and energy ratios when TFO is done using four different milk fortifiers and based on various frequencies of milk measurements.
Study design Ten infants, GA: 26.1 ± 1.3 wks, BW: 890 ± 210 g. Daily measurements (n = 210) of native BM’s fat, protein (NIR milk analyzer), and lactose (UPLC-MS/MS) levels provided the basis for model calculation to add fat, protein and carbohydrates using modular products after FDF with either FM85, FMS, Enfamil, or Similac to meet ESPGHAN recommendations. BM measurement frequencies were 7/wk, 5/wk, 3/wk, 2/wk, 1/wk, and 0/wk (only FDF).
Results Measurement 2/wk increased mean macronutrient intake and day-to-day variation was not higher compared to native BM. Day-to-day variation decreased with increasing frequency of milk analysis (Fig). After adding FDF mean carbohydrate level already exceeded in 3 fortifiers and median fat level in 1 fortifier leading to higher calorie intake than target levels.
TFO 7/wk achieved macronutrient levels close to target when routine fortifier was composed with 1.1 g protein/dL (no fat, no CHO) whereas for measurements 1–2/wk, it was achieved with composition of fat 0.4g/dL, protein 1.2g/dL and carbohydrate 1.1g/dL.
Conclusions Measurements of macronutrient 1–2/wks might provide a reasonable balance between workload and clinical outcome. Due to different composition of fortifiers, either target values for macronutrients or composition of fortifier for use with TFO needs to be reconsidered in order to achieve recommended intake.