New Ways to Provide a Human Milk Fortifier during Breastfeeding.

Providing a human milk fortifier once the preterm infant has started to suckle at the breast can be challenging for the mother and might shorten duration of the breastfeeding period. Fortification is recommended up to term for the normal-growing infant and up to 3 months in growth-retarded infants. After hospital discharge, some mothers may not want to pump, fortify, and bottle-feed the fortifier-milk mixture any longer. They desire to breastfeed their infants directly from the breast, but unfortunately, fortification often interferes with direct breastfeeding. Cup feeding is the most researched fortification method and appears to be safe but cannot be applied during nursing. Another alternative is the supplemental nursing systems, but only a few low-quality studies investigated the method, which is difficult to handle and requires a lot of nursing experience. The use of a finger feeder to administer a fortifier to preterm infants is a new method that enables mothers to exclusively breastfeed their infants and meet their nutritional needs. Mothers reported easy preparation and handling of the fortifier. More than 67% of the infants accepted the device and fortifier application during nursing very well. However, the development of further methods to augment preterm infant nutrition that does not interfere with breastfeeding is of great interest. Future efforts to enable fortification during breastfeeding must be linked to the development of ready-to-use devices containing liquid human milk fortification mixtures.