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Ernesto Valdes MD, Guest Editor

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HUMAN MILK AND HUMAN MILK FORTIFIERS FOR PREEMIES

Speaker Richard Schanler, M.D.  Albert Einstein College of Medicine

 We all know the benefits of Human Milk for Premature Infants. Benefits in:  host defenses (less infections), GI (less NEC), Nutrition, Neurodevelopment, and outcomes related to the duration of human milk.  It is known that Human Milk does not meet the Protein, Sodium, Calcium and Phosphorus needs of our Pre-Term infants. Thus we need Human Milk Fortifiers.

Alkaline Phosphatase activity is higher in Pre-Term Infants fed Human Milk only, as opposed to those fed Human Milk with Human Milk Fortifier.

Calcium retention is comparable to intrauterine Ca accretion rates in infants fed Human Milk with fortifier. Vitamins may be affected in the preparation of Human Milk; so additional vitamins from Human Milk Fortifier are necessary.

Human Milk Feeding Guidelines for Pre-Term Infants < 32 weeks (tube-feeding protocol) are:
Gastrointestinal priming 10-20 ml/kg/day; advancing by 20 ml/kg/day; after 100 ml/kg/d, use Human Milk Fortifier.
Advance fortified human milk to 160 ml/kg/d, full feeds.
Add Iron (~ 2 mg/kg/day) at full feedings.
After 1800 gms. Follow “Big Premie Protocol”.

Breast Feeding Guidelines for Pre-term Infants 32-37 weeks.
Assume competent oral feedings:
1-feed expressed Human Milk or Breastfeed.
2- Ad libitum volume, approximately 180 ml/kg/day (min). Supplement with multiple vitamins 1ml/day for 2 months and iron 2 mg/kg/day until feeding iron containing foods are given.

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