Target Fortification: Considerations for the Clinician
Optimizing Neonatal Nutrition: The Role of Human Milk Fortification
Human milk is the optimal source of nutrition for neonates, providing essential nutrients for growth and brain development. However, due to the high nutritional demands during the postnatal period, fortifying human milk with macro- and micronutrients is often necessary. This practice aims to increase calorie content to between 22-30 calories per ounce, ensuring adequate nutrition for infants.
Understanding Human Milk Composition
The macronutrient composition of human milk can vary significantly. Some lactating individuals may produce milk with less than 20 calories per ounce, while others may produce milk with higher calorie content. Additionally, the nutritional composition of milk can fluctuate throughout the day and from day to day.
Target Fortification: A New Approach
Target fortification is an emerging nutrition practice designed to minimize variations in milk composition. By measuring individual nutrients and adding necessary fortifiers, target fortification aims to maintain optimal protein intake and protein-to-energy ratios, reducing the risk of over- or undernutrition. Preliminary studies suggest that target fortification may promote fat-free mass gain in infants, though further research is needed to confirm its impact on overall weight gain.
Standard Fortification vs. Target Fortification
Standard Fortification: This traditional approach assumes a fixed calorie and macronutrient content in human milk. Fortifiers are added to achieve desired nutritional levels, with modulars used for infants with higher nutritional needs due to medical conditions.
Target Fortification: This method involves analyzing human milk with a milk analyzer to determine its nutritional components. Fortifiers and modular products are then added to achieve specific nutrient targets, resulting in a measured and known nutritional level.
Considerations for Implementation
While target fortification offers promising benefits, its feasibility can be challenging. The process requires a milk analyzer, which may be cost-prohibitive, as well as additional materials like syringes and scales. Developing protocols for milk testing and fortification, along with training staff to implement these protocols safely, is crucial. The added labor and complexity of the process must also be considered.
Challenges with Modulars
Modulars, used in target fortification, present their own challenges. Selecting appropriate modulars that promote tolerance can be difficult due to factors like cost, osmotic load, and availability. Modulars are often powder-based, increasing the risk of bacterial contamination. Safe handling and preparation in a sterile environment are essential to minimize risks. Streamlined processes with double checks can help ensure accuracy and safety.
Conclusion
Providing precise nutrition to nutritionally at-risk infants is an exciting advancement. Continued research into best practices, implementation, feasibility, and safety is essential to optimize neonatal nutrition.
References
de Halleux V, Rigo J. Variability in human milk composition: benefit of individualized fortification in very-low-birth-weight infants. Am J Clin Nutr. 2013 Aug;98(2):529S-35S. doi: 10.3945/ajcn.112.042689.
Parat S, Raza P, Kamleh M, Super D, Groh-Wargo S. Targeted Breast Milk Fortification for Very Low Birth Weight (VLBW) Infants: Nutritional Intake, Growth Outcome and Body Composition. Nutrients. 2020 Apr 21;12(4):1156. doi: 10.3390/nu12041156.