Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA.
Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA.
JPEN J Parenter Enteral Nutr. 2019 Aug;43(6):809-814. doi: 10.1002/jpen.1470. Epub 2018 Nov 19.
Provision of human milk to premature infants optimizes outcomes, but it must be supplemented to meet their nutrient and caloric requirements for growth. Our objective was to quantify the osmolality of human milk mixed with commercially available human milk fortifiers (HMF) and powdered infant formula, as currently fed to premature infants, simulating standard neonatal intensive care unit feeding practices for mixing and refrigerator storage.
Expressed human milk (EHM) samples obtained from mothers of premature infants (≤32 weeks gestation) were mixed with standard commercial products, and osmolalities were quantified.
HMF significantly increased the micronutrient content and osmolality of EHM. Osmolalities were 291 ± 6 mOsm/kg (mean ± SD) for unsupplemented milk, and 505 ± 5 and 315 ± 19 mOsm/kg after supplementation to 24 kcal/oz using 2 current U.S. Liquid EHM fortifiers. When using powdered infant formulas to further increase the caloric content of fortified EHM >24 kcal/oz, osmolalities increased by 10.5-23.0 mOsm/kg for each additional kcal/oz. The use of powdered formulas alone (without HMF) increased osmolality without comparable increases in nutrient content. Refrigeration for 24 hours did not affect osmolalites.
Our finding that several common feeding formulations exceed 450 mOsm/kg, and the lack of evidence of adverse effect, raise the question of whether current maximum osmolality guidelines should be reevaluated to enable optimal nutrition for infants in neonatal intensive care.
为早产儿提供人乳可以优化其结果，但必须补充人乳以满足其生长所需的营养和热量。我们的目的是量化与商业上可获得的人乳强化剂（HMF）和配方粉混合的人乳的渗透压，这些人乳目前被用于早产儿，模拟了混合和冰箱储存的标准新生儿重症监护病房喂养实践。
从早产儿（≤32 周妊娠）的母亲中获取表达的人乳（EHM）样本，并与标准商业产品混合，然后定量渗透压。
HMF 显著增加了 EHM 的微量营养素含量和渗透压。未添加人乳的渗透压为 291±6 mOsm/kg（平均值±标准差），添加 2 种当前美国液体 EHM 强化剂以达到 24 kcal/oz 时，渗透压分别为 505±5 和 315±19 mOsm/kg。当使用配方粉进一步提高强化 EHM 的热量含量>24 kcal/oz 时，每增加 1 kcal/oz，渗透压增加 10.5-23.0 mOsm/kg。单独使用配方粉（不使用 HMF）会增加渗透压，但不会相应增加营养成分含量。冷藏 24 小时不会影响渗透压。
我们发现几种常见的喂养配方的渗透压超过 450 mOsm/kg，而且没有不良反应的证据，这引发了一个问题，即当前的最大渗透压指南是否应该重新评估，以使新生儿重症监护室的婴儿能够获得最佳营养。
