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Fortifier selection and dosage enables control of breast milk osmolarity.
PLoS One. 2020; 15(6):e0233924.Plos

Abstract

BACKGROUND

Human breast milk (BM) fortification is required to feed preterm newborns with less than 32 weeks of gestation. However, addition of fortifiers increases osmolarity and osmolarity values higher than 450 mOsm/kg may be related to gastrointestinal pathology. Hence, fortifier selection and dosage are key to achieve optimal feeding.

OBJECTIVES

To compare the effect on osmolality of adding different fortifications, including recently developed formulations, to BM and to study evolution of osmolarity over time in supplemented BM.

METHODS

Frozen mature BM from 10 healthy mothers of premature newborns was fortified with each of the following human milk fortifiers (HMF): AlmirónFortifier®, NANFM85®, or PreNANFM85®. In addition, fortified BMs were modified with one of the following nutritional supplements (NS): Duocal MCT®, Nutricia® AminoAcids Mix, or Maxijul®. Osmolality of BM alone, fortified and/or supplemented was measured at 1 and 22 hours after their preparation. All samples were kept at 4°C throughout the study.

RESULTS

Osmolality of BM alone was close to 300 mOsm/kg and did not change over 22 hours. When equicaloric amounts of HMF AlmirónFortifier®, NANFM85®, and PreNANFM85® were added to BM, osmolality increased roughly to 480 mOsm/kg with the first two fortifiers and only to 433±6 mOsm/kg with the third one. Upon addition of any of four different NSs to BM modified with AlmirónFortifier® and NANFM85®, osmolality reached values greater than 520 mOsm/kg, while osmolality of PreNANFM85® with two out of the four NSs remained below 490 mOsm/kg. NSs supplementing carbohydrates and hydrolysed proteins resulted into a higher increase of BM osmolarity. Osmolality increased significantly with time and, after 22h, only BM modified with PreNANFM85® remained below 450 mOsm/kg.

CONCLUSIONS

Upon addition of the HMFs tested, BM osmolality increases significantly and keeps raising over time. All HMFs but the recently developed PreNAN FM85® at 4% exceed the AAP recommended threshold for osmolarity of 450 mOsm/kg. Addition of NSs to PreNAN FM85® at 4% significantly increases osmolality above 450 mOsm/Kg. Thus, using PreNAN FM85® at 5% may be preferable to adding nutritional supplements since nutritional recommendations by the ESPGHAN are reached with a lower increase in osmolality.

Authors+Show Affiliations

Neonatology Deparment, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic-Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.Core Laboratory, Clínic Hospital, University of Barcelona, Barcelona, Spain.Institut Químic de Sarrià, Universitat Ramon Llull, Barcelona, Spain.Neonatology Deparment, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic-Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.Core Laboratory, Clínic Hospital, University of Barcelona, Barcelona, Spain.Core Laboratory, Clínic Hospital, University of Barcelona, Barcelona, Spain.Neonatology Deparment, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic-Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.Neonatology Deparment, BCNatal-Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic-Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32479524

Citation

Herranz Barbero, Ana, et al. "Fortifier Selection and Dosage Enables Control of Breast Milk Osmolarity." PloS One, vol. 15, no. 6, 2020, pp. e0233924.
Herranz Barbero A, Rico N, Oller-Salvia B, et al. Fortifier selection and dosage enables control of breast milk osmolarity. PLoS ONE. 2020;15(6):e0233924.
Herranz Barbero, A., Rico, N., Oller-Salvia, B., Aldecoa-Bilbao, V., Macías-Muñoz, L., Wijngaard, R., Figueras-Aloy, J., & Salvia-Roigés, M. (2020). Fortifier selection and dosage enables control of breast milk osmolarity. PloS One, 15(6), e0233924. https://doi.org/10.1371/journal.pone.0233924
Herranz Barbero A, et al. Fortifier Selection and Dosage Enables Control of Breast Milk Osmolarity. PLoS ONE. 2020;15(6):e0233924. PubMed PMID: 32479524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fortifier selection and dosage enables control of breast milk osmolarity. AU - Herranz Barbero,Ana, AU - Rico,Nayra, AU - Oller-Salvia,Benjamí, AU - Aldecoa-Bilbao,Victoria, AU - Macías-Muñoz,Laura, AU - Wijngaard,Robin, AU - Figueras-Aloy,Josep, AU - Salvia-Roigés,MªDolors, Y1 - 2020/06/01/ PY - 2019/12/15/received PY - 2020/05/14/accepted PY - 2020/6/2/entrez PY - 2020/6/2/pubmed PY - 2020/6/2/medline SP - e0233924 EP - e0233924 JF - PloS one JO - PLoS ONE VL - 15 IS - 6 N2 - BACKGROUND: Human breast milk (BM) fortification is required to feed preterm newborns with less than 32 weeks of gestation. However, addition of fortifiers increases osmolarity and osmolarity values higher than 450 mOsm/kg may be related to gastrointestinal pathology. Hence, fortifier selection and dosage are key to achieve optimal feeding. OBJECTIVES: To compare the effect on osmolality of adding different fortifications, including recently developed formulations, to BM and to study evolution of osmolarity over time in supplemented BM. METHODS: Frozen mature BM from 10 healthy mothers of premature newborns was fortified with each of the following human milk fortifiers (HMF): AlmirónFortifier®, NANFM85®, or PreNANFM85®. In addition, fortified BMs were modified with one of the following nutritional supplements (NS): Duocal MCT®, Nutricia® AminoAcids Mix, or Maxijul®. Osmolality of BM alone, fortified and/or supplemented was measured at 1 and 22 hours after their preparation. All samples were kept at 4°C throughout the study. RESULTS: Osmolality of BM alone was close to 300 mOsm/kg and did not change over 22 hours. When equicaloric amounts of HMF AlmirónFortifier®, NANFM85®, and PreNANFM85® were added to BM, osmolality increased roughly to 480 mOsm/kg with the first two fortifiers and only to 433±6 mOsm/kg with the third one. Upon addition of any of four different NSs to BM modified with AlmirónFortifier® and NANFM85®, osmolality reached values greater than 520 mOsm/kg, while osmolality of PreNANFM85® with two out of the four NSs remained below 490 mOsm/kg. NSs supplementing carbohydrates and hydrolysed proteins resulted into a higher increase of BM osmolarity. Osmolality increased significantly with time and, after 22h, only BM modified with PreNANFM85® remained below 450 mOsm/kg. CONCLUSIONS: Upon addition of the HMFs tested, BM osmolality increases significantly and keeps raising over time. All HMFs but the recently developed PreNAN FM85® at 4% exceed the AAP recommended threshold for osmolarity of 450 mOsm/kg. Addition of NSs to PreNAN FM85® at 4% significantly increases osmolality above 450 mOsm/Kg. Thus, using PreNAN FM85® at 5% may be preferable to adding nutritional supplements since nutritional recommendations by the ESPGHAN are reached with a lower increase in osmolality. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32479524/Fortifier_selection_and_dosage_enables_control_of_breast_milk_osmolarity_ L2 - https://dx.plos.org/10.1371/journal.pone.0233924 DB - PRIME DP - Unbound Medicine ER -