title: Target fortification of breast milk: how often should milk analysis be done?
abstract: Target fortification (TFO) reduces natural macronutrient variation in breast milk (BM). Daily BM analysis for TFO increases neonatal intensive care unit work load by 10-15 min/patient/day and may not be feasible in all nurseries. The variation of macronutrient intake when BM analysis is done for various schedules was studied. In an observational study, we analyzed 21 subsequent samples of native 24-h BM batches, which had been prepared for 10 healthy infants (gestational age 26.1 ± 1.3 weeks, birth weight: 890 ± 210 g). Levels of protein and fat (validated near-infrared milk analyzer), as well as lactose (UPLC-MS/MS) generated the database for modelling TFO to meet recommendations of European Society for Paediatric Gastroenterology Hepatology and Nutrition. Intake of macronutrients and energy were calculated for different schedules of BM measurements for TFO (n = 1/week; n = 2/week; n = 3/week; n = 5/week; n = 7/week) and compared to native and fixed dose fortified BM. Day-to-day variation of macronutrients (protein 20%, carbohydrate 13%, fat 17%, energy 10%) decreased as the frequency of milk analysis increased and was almost zero for protein and carbohydrate with daily measurements. Measurements two/week led to mean macronutrient intake within a range of ± 5% of targeted levels. A reduced schedule for macronutrient measurement may increase the practical use of TFO. To what extent the day-to-day variation affects growth while mean intake is stable needs to be studied.
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada. nielsrochow@gmail.com.
authors.forename: Niels
authors.initials: N
authors.lastname: Rochow
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada. gefusch@mcmaster.ca.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fusch
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada. zapantabianca@gmail.com.
authors.forename: Bianca
authors.initials: B
authors.lastname: Zapanta
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada. anaamali@gmail.com.
authors.forename: Anaam
authors.initials: A
authors.lastname: Ali
authors.affiliation: Department of Mathematics and Statistics, McMaster University, 1280 Main Street West, Hamilton, On L8S4K1, Canada. baruis@math.mcmaster.ca.
authors.forename: Sandip
authors.initials: S
authors.lastname: Barui
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada. fusch@mcmaster.ca.
authors.forename: Christoph
authors.initials: C
authors.lastname: Fusch
mesh_terms: D001724:Birth Weight; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007234:Infant, Premature / Q000254:growth & development; D019102:Infant, Very Low Birth Weight / Q000254:growth & development; D008894:Milk Proteins / Q000008:administration & dosage / Q000032:analysis; D008895:Milk, Human / Q000737:chemistry*; D053719:Tandem Mass Spectrometry
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D008894:Milk Proteins
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