Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification

Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the...

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Published in:Frontiers in pediatrics Vol. 7; p. 76
Main Authors: Arslanoglu, Sertac, Boquien, Clair-Yves, King, Caroline, Lamireau, Delphine, Tonetto, Paola, Barnett, Debbie, Bertino, Enrico, Gaya, Antoni, Gebauer, Corinna, Grovslien, Anne, Moro, Guido E., Weaver, Gillian, Wesolowska, Aleksandra Maria, Picaud, Jean-Charles
Format: Journal Article
Language:English
Published: Switzerland Frontiers 2019
Frontiers Media S.A
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ISSN:2296-2360, 2296-2360
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Abstract Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.
AbstractList Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that “Standard Fortification,” which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of “Individualized Fortification” to optimize nutrient intake. “Adjustable Fortification” and “Targeted Fortification” are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.
Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.
Author Gaya, Antoni
Lamireau, Delphine
Wesolowska, Aleksandra Maria
Grovslien, Anne
Bertino, Enrico
Weaver, Gillian
Arslanoglu, Sertac
Boquien, Clair-Yves
Tonetto, Paola
Moro, Guido E.
Barnett, Debbie
Gebauer, Corinna
King, Caroline
Picaud, Jean-Charles
AuthorAffiliation 5 Neonatal Unit of Turin University, City of Health and Science of Turin , Turin , Italy
7 Banc de Teixits, Fundaciò Banc Sang i Teixits de les Illes Balears , Palma de Mallorca , Spain
9 Neonatal Unit, Milk Bank, Oslo University Hospital , Oslo , Norway
1 Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University , Istanbul , Turkey
14 Division of Neonatology, Hôpital de la Croix-Rousse , Lyon , France
6 Greater Glasgow and Clyde Donor Milk Bank, Royal Hospital for Sick Children , Glasgow , United Kingdom
3 Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust , London , United Kingdom
4 Lactariums de Bordeaux-Marmande, Pôle Pédiatrique, Centre Hospitalo-Universitaire (CHU) de Bordeaux , Bordeaux , France
13 CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1 , Pierre Bénite , France
12 Department of Neonatology, Faculty of Health Science, Medical University of Warsaw , Warsaw , Poland
8 Abteilung Neonatologie Klinik und Poliklini
AuthorAffiliation_xml – name: 2 PhAN, Institut National de la Recherche Agronomique (INRA), Université de Nantes, CRNH-Ouest , Nantes , France
– name: 10 Associazione Italiana Banche del Latte Umano Donato (AIBLUD) , Milan , Italy
– name: 6 Greater Glasgow and Clyde Donor Milk Bank, Royal Hospital for Sick Children , Glasgow , United Kingdom
– name: 7 Banc de Teixits, Fundaciò Banc Sang i Teixits de les Illes Balears , Palma de Mallorca , Spain
– name: 4 Lactariums de Bordeaux-Marmande, Pôle Pédiatrique, Centre Hospitalo-Universitaire (CHU) de Bordeaux , Bordeaux , France
– name: 3 Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust , London , United Kingdom
– name: 13 CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1 , Pierre Bénite , France
– name: 5 Neonatal Unit of Turin University, City of Health and Science of Turin , Turin , Italy
– name: 9 Neonatal Unit, Milk Bank, Oslo University Hospital , Oslo , Norway
– name: 8 Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche , Leipzig , Germany
– name: 1 Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University , Istanbul , Turkey
– name: 14 Division of Neonatology, Hôpital de la Croix-Rousse , Lyon , France
– name: 12 Department of Neonatology, Faculty of Health Science, Medical University of Warsaw , Warsaw , Poland
– name: 11 Hearts Milk Bank, Rothamsted Research Institute , Harpenden , United Kingdom
Author_xml – sequence: 1
  givenname: Sertac
  surname: Arslanoglu
  fullname: Arslanoglu, Sertac
– sequence: 2
  givenname: Clair-Yves
  surname: Boquien
  fullname: Boquien, Clair-Yves
– sequence: 3
  givenname: Caroline
  surname: King
  fullname: King, Caroline
– sequence: 4
  givenname: Delphine
  surname: Lamireau
  fullname: Lamireau, Delphine
– sequence: 5
  givenname: Paola
  surname: Tonetto
  fullname: Tonetto, Paola
– sequence: 6
  givenname: Debbie
  surname: Barnett
  fullname: Barnett, Debbie
– sequence: 7
  givenname: Enrico
  surname: Bertino
  fullname: Bertino, Enrico
– sequence: 8
  givenname: Antoni
  surname: Gaya
  fullname: Gaya, Antoni
– sequence: 9
  givenname: Corinna
  surname: Gebauer
  fullname: Gebauer, Corinna
– sequence: 10
  givenname: Anne
  surname: Grovslien
  fullname: Grovslien, Anne
– sequence: 11
  givenname: Guido E.
  surname: Moro
  fullname: Moro, Guido E.
– sequence: 12
  givenname: Gillian
  surname: Weaver
  fullname: Weaver, Gillian
– sequence: 13
  givenname: Aleksandra Maria
  surname: Wesolowska
  fullname: Wesolowska, Aleksandra Maria
– sequence: 14
  givenname: Jean-Charles
  surname: Picaud
  fullname: Picaud, Jean-Charles
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30968003$$D View this record in MEDLINE/PubMed
https://hal.inrae.fr/hal-02628588$$DView record in HAL
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Copyright © 2019 Arslanoglu, Boquien, King, Lamireau, Tonetto, Barnett, Bertino, Gaya, Gebauer, Grovslien, Moro, Weaver, Wesolowska and Picaud. 2019 Arslanoglu, Boquien, King, Lamireau, Tonetto, Barnett, Bertino, Gaya, Gebauer, Grovslien, Moro, Weaver, Wesolowska and Picaud
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Keywords nutrition
prematurity
protein
adjustable fortification
growth
human milk
individualized fortification
Language English
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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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This article was submitted to Neonatology, a section of the journal Frontiers in Pediatrics
Edited by: Maximo Vento, Hospital Universitari i Politècnic La Fe, Spain
European Milk Bank Association (EMBA) Working Group on Human Milk Fortification
Reviewed by: Miguel Saenz De Pipaon, University Hospital La Paz, Spain; Catherine Mullié, University of Picardie Jules Verne, France; Ehsan Khafipour, University of Manitoba, Canada
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PublicationTitle Frontiers in pediatrics
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Snippet Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits...
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SubjectTerms adjustable fortification
Food and Nutrition
growth
Human health and pathology
human milk
individualized fortification
Life Sciences
nutrition
Pediatrics
prematurity
Title Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification
URI https://www.ncbi.nlm.nih.gov/pubmed/30968003
https://www.proquest.com/docview/2207158101
https://hal.inrae.fr/hal-02628588
https://pubmed.ncbi.nlm.nih.gov/PMC6439523
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