title: Protein content and fortification of human milk influence gastroesophageal reflux in preterm infants.
abstract: OBJECTIVE
  : Preterm human milk (HM) may provide insufficient energy and nutrients and thus may need to be fortified. Our aim was to determine whether fat content, protein content, and osmolality of HM before and after fortification may affect gastroesophageal reflux (GER) in symptomatic preterm infants.
  
  
  METHODS
  : Gastroesophageal reflux was evaluated in 17 symptomatic preterm newborns fed naïve and fortified HM by combined pH/intraluminal-impedance monitoring (pH-MII). Human milk fat and protein content was analysed by a near-infrared reflectance analysis. Human milk osmolality was tested before and after fortification. Gastroesophageal reflux indexes measured before and after fortification were compared and were also related to HM fat and protein content and osmolality before and after fortification.
  
  
  RESULTS
  : An inverse correlation was found between naïve HM protein content and acid reflux index (RIpH: P = 0.041, rho =-0.501). After fortification, osmolality often exceeded the values recommended for infant feeds; furthermore, a statistically significant (P < 0.05) increase in nonacid reflux indexes was observed.
  
  
  CONCLUSIONS
  : Protein content of naïve HM may influence acid GER in preterm infants. A standard fortification of HM may worsen nonacid GER indexes and, due to the extreme variability in HM composition, may overcome both recommended protein intake and HM osmolality. Thus, an individualised fortification, based on the analysis of the composition of naïve HM, could optimise both nutrient intake and feeding tolerance.
authors.affiliation: Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy. arianna.aceti@gmail.com
authors.forename: Arianna
authors.initials: A
authors.lastname: Aceti
authors.forename: Luigi
authors.initials: L
authors.lastname: Corvaglia
authors.forename: Vittoria
authors.initials: V
authors.lastname: Paoletti
authors.forename: Elisa
authors.initials: E
authors.lastname: Mariani
authors.forename: Gina
authors.initials: G
authors.lastname: Ancora
authors.forename: Silvia
authors.initials: S
authors.lastname: Galletti
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faldella
mesh_terms: D004044:Dietary Proteins / Q000032:analysis / Q000494:pharmacology / Q000627:therapeutic use*; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005527:Food, Fortified; D005764:Gastroesophageal Reflux / Q000178:diet therapy*; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000178:diet therapy*; D008895:Milk, Human / Q000737:chemistry*; D009994:Osmolar Concentration; D012720:Severity of Illness Index
chemical_list: D004044:Dietary Proteins