Italian Association of Human Milk Banks, Milan, Italy.
J Perinat Med. 2010 May;38(3):233-8. doi: 10.1515/jpm.2010.073.
Preterm infants fed fortified human milk (HM) in standard (STD) fashion grow slower than preterm formula fed infants. Recently, low protein intake has been proven to be the primary limiting factor responsible for this growth failure. The main reason of protein undernutrition despite fortification is that STD fortification is based on the customary assumptions about the composition of HM. However, the protein concentration of preterm HM is variable and decreases with the duration of lactation. Also, the protein concentration of banked donor milk, which is most often provided by mothers of term infants, is likely to be lower. Hence, most of the HM fed to preterm infants during the fortification period is likely to have an inadequately low protein concentration. This hypothesis has been confirmed very recently by comparing the assumed and actual protein intakes in preterm infants fed fortified HM. Novel fortification models have been devised to deal with the problem of ongoing protein undernutrition. Individualized fortification is the recommended method to optimize HM fortification. There are two models of individualization: "adjustable fortification" and "targeted fortification". Both ways are feasible and effective in improving protein intakes and growth. Adjustable fortification has the advantage of being practical and avoids excessive protein intakes.
早产儿以标准（STD）方式喂养强化人乳（HM）比早产儿配方喂养的婴儿生长速度慢。最近，已经证明低蛋白摄入是导致这种生长失败的主要限制因素。尽管进行了强化，但蛋白质营养不良的主要原因是 STD 强化是基于对 HM 组成的习惯假设。然而，早产儿 HM 的蛋白质浓度是可变的，并随着哺乳期的延长而降低。此外，银行捐赠母乳的蛋白质浓度（通常由足月婴儿的母亲提供）可能较低。因此，在强化期间，大多数早产儿喂养的 HM 可能蛋白质浓度过低。最近通过比较强化 HM 喂养的早产儿的假设和实际蛋白质摄入量证实了这一假设。已经设计了新的强化模型来解决持续存在的蛋白质营养不良问题。个性化强化是优化 HM 强化的推荐方法。有两种个体化模型：“可调节强化”和“靶向强化”。这两种方法都可行且有效，可以提高蛋白质摄入量和生长。可调节强化具有实用的优势，并且可以避免蛋白质摄入过多。
