Feeding very small premature infants with concentrated breast milk

The use of concentrated breast milk was prospectively studied in 26 very small premature babies with a birth weight of 1,010-1,500 g. 57 premature babies of the same birth weight group born in the two preceding years and fed normal pooled breast milk served as a control group. Fresh breast milk was enriched using lyophilized breast milk yielding a calory content of 103 cal/100 ml. Early intermittent nasogastric feeding using this milk enabled full oral calory supply from the 5th day on. 130 ml/kg/day of enriched breast milk yields 134 cal/kg per day with somewhat less fat but more protein (2.8 g/kg vs 2.2 g/kg) and sodium (1.9 mmol vs 1.5 mmol) than 200 ml/kg/day of ordinary breast milk. About 50% of the study patients and the control group needed intensive care with mechanical ventilation. Mortality was 15% and 28%, respectively. Necrotizing enterocolitis was rare in both groups (3.3 vs 3.5%). Due to extragastric complications oral feeding had to be reduced in 18% (study group) and in 27% (ordinary breast milk), the most frequent indication was a patent ductus arteriosus with heart insufficiency. Postnatal weight gain was comparatively good with a mean increment of 112 g in the second and 150 g in the third week. Growth of body length during the first three weeks was on average 0.72 cm/week, head circumference increased 0.57 cm/week. However, in the control group similar results were noted. During the second week of life patients fed concentrated breast milk had somewhat higher plasma sodium und urea values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Plasma carnitine and breast milk carnitine intake in premature infants

Ten premature infants with a mean gestational age of 29 weeks (range, 27-32) and a mean birth weight of 1,294 g (range, 930-2,300) and without complications at birth were studied during the first 14 days after birth. Their breast milk intake was recorded and the carnitine content determined in each daily portion. During the first week, the daily mean carnitine intake was low and increased to 6-7 mumoles/kg and day during the second week. Breast milk carnitine concentration ranged from 17 to 148 mumoles/L. Plasma carnitine and its derivatives did not change during the observation period. No relationship was found between the individual cumulative breast milk carnitine intake and total plasma carnitine levels or between carnitine and its derivatives and nonesterified fatty acids or 3-OH-butyrate. The urinary carnitine excretion, in millimoles of carnitine per mole of creatinine, was higher during the second week. In other studies, declining plasma carnitine levels have been observed in premature infants on total parenteral nutrition. The results from this study indicated that premature infants without complicating disorders were able to maintain their plasma carnitine levels.     

Milk curd obstruction in premature infants receiving fortified expressed breast milk

Aim:   Milk curd obstruction is one of the less common causes of neonatal bowel obstruction. It has been described in premature infants who received high caloric formula feeds. We report presentation, management and outcome of premature neonates who developed milk curd obstruction while being fed fortified expressed breast milk.
Methods:   A retrospective case note review of babies who were treated for milk curd obstruction in Royal Children's Hospital and Mater Children's Hospital in Brisbane between 2001 and 2007 was performed.
Results:   Nine preterm neonates developed milk curd obstruction (mean gestational age 27 weeks). All babies received ortified expressed breast milk. Symptoms presented were those of bowel obstruction in the majority of cases. Laparotomy was required in eight babies, one had a pre-existing ileostomy that was washed out. Two babies died shortly after surgery, while two followed several months later.
Conclusion:   The diagnosis of milk curd obstruction should be considered in all premature babies with signs of bowel obstruction who are fed expressed breast milk with caloric fortification.     

A comparative study of a premature infant formula and preterm breast milk for low birthweight infants

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparative study of a premature infant formula and preterm breast milk for low birthweight infants

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000-1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty-eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C. Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra-uterine growth rates, whereas that for Group C approximated the predicted intra-uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem-fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease. Lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P<0.05). Overall both PTM and Alprem were well tolerated with the four cases of necrotizing enterocolitis and five cases of transient gastrointestinal intolerance distributed equally among the groups. Alprem is a satisfactory alternative to PTM for the feeding of LBW infants as it provides adequate nutrition and supports a growth rate in excess of that in utero without stressing the infant's metabolic or excretory systems.     

Metoclopramide effect on faltering milk production by mothers of premature infants

Metoclopramide treatment has been shown to augment milk production by stimulating prolactin secretion in women in whom lactational insufficiency develops after a full-term pregnancy. The effect of metoclopramide therapy in 23 women who were delivered of premature infants (birth weight 1,314 +/- 115 g, gestational age 30.4 +/- 0.7 weeks) and who were having difficulty maintaining milk production with milk expression was evaluated. Each woman had noted a gradual decrease in the total daily volume of expressed milk during the first several weeks of lactation. Maternal metoclopramide therapy was started at a mean of 32.0 +/- 3.7 days postpartum, after a review of diet and milk expression technique and an increase in the number of expressions per day failed to increase milk production. Daily milk production increased significantly from 93.3 +/- 18.0 mL/d to 197.4 +/- 32.3 mL/d between the first and seventh day of therapy. This increase was associated with significantly increased basal serum prolactin levels, from 18.1 +/- 3.3 ng/mL to 121.8 +/- 21.5 ng/mL. Although milk expression resulted in a variable increase in serum prolactin levels prior to metoclopramide treatment, milk expression did not produce any additional prolactin response in the treated women, with mean basal levels of 157.8 +/- 15.4 ng/mL v mean peak levels of 144.5 +/- 12.2 ng/mL. No major side effects were reported by the women, and no untoward effects were noted in the infants fed milk expressed while their mothers were being treated with metoclopramide.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of human milk for premature infants

Various methods have been reported and used clinically to augment the nutrient supply for human milk-fed premature infants. These methods include specialized maltinutrient powdered mixtures (fortifiers), complete liquid formulas designed to be mixed with human milk, complete powdered formulas to be mixed with human milk, and alternate feeding of human milk and preterm formula. Although the optimum nutrition of premature infants is unknown, data are accumulating to suggest that human milk, fortified with additional nutrients, is appropriate for tube-fed infants. The use of fortified human milk typically provides premature infants adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/d compared with unfortified human milk. Data are needed to determine the precise quantity of nutrients to be added as supplements. Nutrient interactions have not been explored in detail. Although large quantities of calcium seem to be needed, the exogenous calcium may affect fat absorption adversely. Manipulation of milk may affect the intrinsic host-defense properties of the milk. Compared with preterm formula, the feeding of fortified human milk may provide significant protection from infection and NEC. Lastly, the potential stimulation of an enteromammary pathway through skin-to-skin contact provides species-specific antimicrobial protection for premature infants. Several of these areas require additional exploration. Thus, for premature infants, neonatal centers should encourage the feeding of fortified human milk, together with skin-to-skin contact, as reasonable methods to enhance milk production while potentially facilitating the development of an enteromammary response.     

Nutrition of very low birth-weight premature infants with enriched breast milk during the adjustment phase

To enable an enteral nutrition in very low birth weight infants appropriate for gestational age, adapted to the high nutritional requirements, pooled human milk from mothers delivered preterm was enriched with human milk lyophilisate 6 g/100 ml. The concentrations of protein increase from 11.8 +/- 1.2 to 15.8 +/- 2.1 g/l and the non-protein energy substrates raise in the same proportion. Osmolality increases from 291.6 +/- 11.2 to 384.9 +/- 19.6 mosmol/l. The higher protein intake was tolerated without relevant metabolic imbalances. Only small increasing of amino acids concentrations in serum and a higher renal excretion of amino acids could be observed. The nitrogen balance was equalized during the first two days of life and positive from the 3rd day of life. Nitrogen retention was significantly higher in the group fed human milk lyophilisate enriched human milk from the 2nd day of life. Also the postnatal weight losses were significantly lower and the birth weight was reached significantly earlier. Human milk lyophilisate enriched human milk can be recommended for nutrition of very low birth weight infants appropriate for gestational age from the first day of life.     

Feeding premature and newborn infants with native mother's milk

Over two years 206 neonates received their mothers milk, 308 were given a formula milk. A dip-slide method, well-known from urine diagnostics (Uricult) was used for bacteriological examination. Breast milk in good condition was given untreated to the neonates. The incidence of intestinal infections was much less in babies who received breast-milk. The anti-infective properties of human milk could be demonstrated.     

Growth of premature infants fed own mother's milk supplied with two milk formulas

The purpose of the authors in this article was to evaluate the effects of supplementing maternal milk with two different caloric formulas on the growth of premature newborns until they reached 40 weeks of post-conceptional age. Seventy premature infants weighing < 1750g at birth were randomized: 35 adequate for gestational age (AGA) and 35 small for gestational age received maternal milk and either a special preterm formula or a modified formula. Anthropometric measurements and clinical evaluations were used to determine the nutritional status and the postnatal growth of these infants, who were analyzed in six different moments: at maximum weight loss, at return to birth weight, at definite weight gain, when exclusively fed with formula, at 2000g, and when they reached 40 weeks of post-conceptional age. The AGA premature newborns on preterm formula had greater daily weight gain, cephalic circumference increase and growth. The SGA premature newborns on preterm formula had greater daily weight gain and cephalic circumference increase observed from the third week of life onward. The AGA premature newborns on modified formula had less weight gain and smaller increments in the cephalic circumference. The SGA premature on modified formula had the worst anthropometric results. The preterm formula was more efficient than the modified formula in promoting postnatal growth of AGA and SGA premature infants. We believe that, due to their special characteristics, SGA premature should receive individualized nutritional caloric planning