Premature babies best off with human-based milk fortifiers, finds study

13 Aug 2020 --- Human-based milk fortifiers may have better health outcomes for severely underweight premature babies compared to traditional, cow’s milk-derived fortifier (CMDF). This is the latest suggestion from a US-UK study that found that babies who were fed cow milk fortifiers were more than three times as likely to develop necrotizing enterocolitis (NEC) and more than twice as likely to develop retinopathy of prematurity, an eye disorder that can lead to blindness.

The researchers from the University of Missouri (MU) and the University College in London performed a meta-analysis on various studies involving more than 450 severely underweight, premature babies in the US, Canada and Austria who received either traditional cow-based milk fortifiers or human-based milk fortifiers. 

“We found strong evidence that using CMDF, even with a 100 percent human milk-based diet, was associated with an increased risk of major neonatal morbidities. This finding is consistent with previous studies, including randomized clinical trials, cohort studies, systematic reviews and meta-analyses, which indicated that feeding cow’s milk-based products was associated with increased risk of multiple major neonatal morbidities,” the study reads. 

“Everyone wants what’s best for these underweight, premature babies. Choosing the best type of milk fortifiers for feeding can help lead to improved health outcomes,” says co-author Jan Sherman, Professor at the MU Sinclair School of Nursing. 

“Nearly half of neonatal intensive care units in the US, including the one at MU Children’s Hospital, are already using human-based milk fortifiers. If we can reduce these cases of necrotizing enterocolitis, preserve their eyesight and reduce the risk of infection, that will benefit the babies’ health in the long term,” she adds.

Click to EnlargeNeonatal intensive care units provide “preemies” milk fortifiers in the form of cow’s milk or manufactured from donor breast milk.One factor that may have a significant bearing on these findings is that even with a 100 percent human milk-based diet, cow’s milk protein consumption of very low birthweight (VLBW) infants was still unexpectedly high. The current guideline that switches out the use of preterm formula for the use of donor milk is focused on maximizing human milk intake to improve outcomes, the study notes. 

“Despite the increased use of human milk in modern neonatal care as a base diet, we found a greater risk of critical morbidities with CMDF compared with human milk-derived fortifiers. This burden of morbidity provides evidence that the benefits of a human milk-based diet might be, in part, counteracted by multiple adverse outcomes relating to the use of CMDF,” the study authors further highlight.

Breast is best – in every case?
Milk from the parents of the baby in question, or “mother’s own milk” (MOM), is strongly recommended for VLBW preterm infants but does not fully meet their nutritional needs, traditionally met by adding a CMDF to MOM. Should MOM be insufficient, preterm formula and cow’s milk-based products can play an essential role in current neonatal practice in promoting growth. 

However, the study found evidence that indicates that VLBW infants fed partly or wholly on cow milk products may have a greater risk of adverse outcomes relating to NEC, late-onset sepsis, mortality, retinopathy of prematurity, bronchopulmonary dysplasia, brain development, cardiovascular risk, bone health, atopic disease and structural development of the heart, lungs and great vessels. 

Commenting on the study, Arla Foods Ingredients tells NutritionInsight that the company supports the World Health Organization (WHO) recommendation for exclusive breastfeeding for the first six months of an infant’s life. The WHO also advises continued breastfeeding up to the age of two or beyond in combination with nutritionally appropriate complementary foods.

NutritionInsight also recently caught up with infant formula experts from Lactalis, Lallemand and Jennewein Biotechnologie regarding innovation in this space in light of World Breastfeeding Week celebrated earlier this month.

By Anni Schleicher

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