Neonatology, Surya Hospitals, Mumbai, Maharashtra, India.
Neonatal Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):232-237. doi: 10.1136/archdischild-2019-317503. Epub 2020 Oct 16.
To evaluate whether a pragmatic corrected fortification (CF) model achieves recommended target protein and calorie content of human milk (HM) for preterm infants when compared with standard fixed-dose fortification (SF).
In this prospective non-interventional study, we enrolled mothers of infants with birth weight ≤1500 g fed exclusive HM. Infants with chromosomal or intestinal disorders were excluded. A total of 405 HM samples from 29 mothers and 45 donor milk samples were analysed for macronutrient content using a real-time HM analyser. A stepwise CF model was derived based on published data on HM calorie and protein content corrected for lactation stage and milk type. We applied both models to the measured protein and calorie content for all HM samples and compared the proportion of samples achieving target nutrient requirement in each group.
Target protein and calorie content of feed was achieved in 68% of HM samples with CF, compared with 5% samples with SF model (p<0.0001). For mother's own milk, none of the samples met the target macronutrient range with SF fortification during later lactation periods (≥week 5). With SF, over 40% of infants had poor growth (decline in weight z-score ≥0.8 SD) by 8 weeks. The final feed osmolality was acceptable for all fortification steps of the CF model.
The proposed CF model significantly improved the final protein and calorie content of HM with acceptable osmolality. It provides a proactive option to improve nutrient intake in premature infants.
评估实用校正强化（CF）模型与标准固定剂量强化（SF）相比，是否能使早产儿配方奶达到推荐的蛋白质和热量目标。
在这项前瞻性非干预性研究中，我们招募了出生体重≤1500g的婴儿的母亲，这些婴儿只接受人乳（HM）喂养。排除有染色体或肠道疾病的婴儿。使用实时 HM 分析仪分析了 29 位母亲和 45 位捐赠者的共 405 个人乳样本的宏量营养素含量。根据发表的关于校正泌乳阶段和乳型的人乳卡路里和蛋白质含量数据，我们推导出了一个逐步 CF 模型。我们将这两种模型应用于所有 HM 样本的测量蛋白质和卡路里含量，并比较了每组达到目标营养素需求的样本比例。
与 SF 模型相比，CF 模型使 68%的 HM 样本达到了目标蛋白质和热量含量，而 SF 模型仅为 5%（p<0.0001）。对于母亲自己的奶，在后期泌乳期（≥第 5 周），SF 强化剂没有一个样本能达到目标宏量营养素范围。使用 SF，超过 40%的婴儿在 8 周时体重 Z 分数下降≥0.8 SD，生长不良。所有 CF 模型的强化步骤的最终喂养渗透压均可以接受。
所提出的 CF 模型显著提高了 HM 的最终蛋白质和热量含量，渗透压可接受。它为改善早产儿的营养摄入提供了一种积极的选择。
