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Andrew B. Kairalla MD, Editor

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Human Milk Fortifiers

Effects of Powdered Human Milk Fortifiers on the Antibacterial Actions of Human Milk.  Chan GM. Journal of Perinatology (2003) 23: 620-623.

Objectives: To evaluate the effects of powdered fortifiers and the addition of iron and medium-chain triglycerides on preterm human milk antibacterial activity.

Study Design: Human milk samples were obtained from 42 preterm lactating mothers after the first week of postnatal life. Enfamil (EHMF) and Similes (SHMF) Human Milk Fortifiers were evaluated. All mothers were healthy and were on no medications except for vitamins during lactation. The effects of each fortifier against E. coli (E. coli), Staphylococcus (Staph), Enterobacter sakazakii (ES), and Group B Streptococcus (GBS) were measured by the filter paper method and growth of the bacteria with human milk alone as control. The addition of iron and medium-chain triglycerides (MCT) to human milk was also tested.

Results: Human milk inhibited the growth of E. coli, Staph, ES, and GBS. Only the SHMF and the addition of MCT had similar antibacterial action as human milk alone. EHMF and the addition of iron to human milk removed the milk's antibacterial action against these four organisms.

Conclusions: Preterm human milk has antimicrobial activity against E. coli, Staph, ES, and GBS. This activity can be affected by the addition of iron and fortifiers that contain iron.


Comments: Use caution when interpreting these results.  Bacterial growth inhibition in vitro may have little correlation with neonatal infection.  I am aware of no studies that demonstrate a higher nosocomial infection rate with certain human milk fortifiers or with iron supplementation.  In view of the importance of iron supplementation in premature infants (see 1-028), I would not recommend limiting enteral iron supplementation in growing premature infants until we have more definitive studies concerning the potential infection risks. ABK.
 

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