Valentine Christina J, Morrow Georgia, Reisinger Amanda, Dingess Kelly A, Morrow Ardythe L, Rogers Lynette K
The Division of Obstetrics and Gynecology, The University of Cincinnati, Cincinnati, OH, 45220, USA2OhioHealth Mothers' Milk Bank of Ohio, Columbus, OH, 43215, USA3Akron Children's Hospital, Akron, OH, 44308, USA4Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Padualaan 8, 3584 CD, Utrecht, The Netherlands5Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA6Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA.
OhioHealth Mothers' Milk Bank of Ohio, Columbus, OH, 43215, USA.
Nutrients. 2017 Mar 18;9(3):302. doi: 10.3390/nu9030302.
Mother's own milk is the first choice for feeding preterm infants, but when not available, pasteurized human donor milk (PDM) is often used. Infants fed PDM have difficulties maintaining appropriate growth velocities. To assess the most basic elements of nutrition, we tested the hypotheses that fatty acid and amino acid composition of PDM is highly variable and standard pooling practices attenuate variability; however, total nutrients may be limiting without supplementation due to late lactational stage of the milk.
A prospective cross-sectional sampling of milk was obtained from five donor milk banks located in Ohio, Michigan, Colorado, Texas-Ft Worth, and California. Milk samples were collected after Institutional Review Board (#07-0035) approval and informed consent. Fatty acid and amino acid contents were measured in milk from individual donors and donor pools (pooled per Human Milk Banking Association of North America guidelines). Statistical comparisons were performed using Kruskal-Wallis, Spearman's, or Multivariate Regression analyses with center as the fixed factor and lactational stage as co-variate.
Ten of the fourteen fatty acids and seventeen of the nineteen amino acids analyzed differed across Banks in the individual milk samples. Pooling minimized these differences in amino acid and fatty acid contents. Concentrations of lysine and docosahexaenoic acid (DHA) were not different across Banks, but concentrations were low compared to recommended levels.
Individual donor milk fatty acid and amino acid contents are highly variable. Standardized pooling practice reduces this variability. Lysine and DHA concentrations were consistently low across geographic regions in North America due to lactational stage of the milk, and thus not adequately addressed by pooling. Targeted supplementation is needed to optimize PDM, especially for the preterm or volume restricted infant.
母乳是喂养早产儿的首选，但在无法获得母乳时，常使用巴氏杀菌的人乳捐赠奶（PDM）。喂养PDM的婴儿在维持适当生长速度方面存在困难。为了评估营养的最基本要素，我们检验了以下假设：PDM的脂肪酸和氨基酸组成高度可变，标准混合方法可减弱这种变异性；然而，由于乳汁处于哺乳后期，不添加营养成分的话，总营养素可能会受限。
从位于俄亥俄州、密歇根州、科罗拉多州、德克萨斯州沃思堡市和加利福尼亚州的五家母乳库进行了前瞻性横断面乳汁采样。乳汁样本在获得机构审查委员会（#07 - 0035）批准并取得知情同意后采集。对各个捐赠者的乳汁以及捐赠奶库（按照北美母乳库协会指南混合）中的乳汁进行了脂肪酸和氨基酸含量测定。使用以中心为固定因素、哺乳阶段为协变量的Kruskal - Wallis检验、Spearman检验或多元回归分析进行统计学比较。
在各个乳汁样本中，所分析的14种脂肪酸中的10种以及19种氨基酸中的17种在不同母乳库之间存在差异。混合操作使氨基酸和脂肪酸含量的这些差异最小化。赖氨酸和二十二碳六烯酸（DHA）的浓度在不同母乳库之间没有差异，但与推荐水平相比浓度较低。
各个捐赠者乳汁的脂肪酸和氨基酸含量高度可变。标准化的混合操作可降低这种变异性。由于乳汁处于哺乳后期，北美不同地理区域的赖氨酸和DHA浓度一直较低，因此混合操作无法充分解决这一问题。需要进行有针对性的补充以优化PDM，特别是对于早产儿或奶量受限的婴儿。
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