title: [Guidelines for multivitamin administration in fortified human milk prepared for preterm infants].
abstract: BACKGROUND
  To reach nutritional standards, human milk has to have 2g/dL of protein. In 2013, Lafeber stated that when human milk is fortified up to 2g/dL, it may increase its osmolality up to 500 mOsm/kg. He also warned that care must be taken when adding a drug or vitamins to human milk.
  
  
  OBJECTIVE
  We studied, for the first time, the impact of adding multivitamins (ADEC) on human fortified milk osmolality.
  
  
  METHODS
  The osmolality of 36 pasteurized, fortified human milk samples was measured. The amount of milk required as a solvent to maintain osmolality below 500 mOsm/kg was then determined.
  
  
  RESULTS
  The osmolality of 2mL of fortified human milk reached up to 750 mOsm/kg when the multivitamins ADEC was added. The osmolality decreased proportionately as the solution was diluted and if vitamins are added in two half-doses each time. It is only with 20mL of milk that the osmolality lowers to its initial rate of 430 mOsm/kg. The stronger the milk's fortification is, the greater impact it has on the milk's osmolality.
  
  
  CONCLUSIONS
  New nutritional recommendations for premature infants are needed. In the meantime, when the fortified milk intake is under 20mL, it is preferable to extend parenteral intakes with fat-soluble vitamins or reduce doses of vitamins in milk. Also, we should use enriched human milk as a fortifier and be cautious with indiscriminate fortification or when adding drugs and electrolyte solutions.
authors.affiliation: Réseau médical, lactarium régional d'Île-de-France, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France; NICU, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France. Electronic address: virginie.rigourd@nck.aphp.fr.
authors.forename: V
authors.initials: V
authors.lastname: Rigourd
authors.affiliation: Service de diagnostic biologique automatisé, HUPC, site Cochin, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
authors.forename: I
authors.initials: I
authors.lastname: Dridi Brahim
authors.affiliation: NICU, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Smii
authors.affiliation: NICU, hôpital Corbeil, 116, boulevard Jean-Jaures, 91106 Corbeil-Essonnes, France.
authors.forename: H
authors.initials: H
authors.lastname: Razafimahefa
authors.affiliation: NICU, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Quetin
authors.affiliation: NICU, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Leroy
authors.affiliation: NICU, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Pichon
authors.affiliation: NICU, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Giuseppi
authors.affiliation: Laboratoire Crinex, 3, rue de Gentilly, BP 337, 92541 Montrouge cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Berthier
authors.affiliation: Réseau médical, lactarium régional d'Île-de-France, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Pommeret
authors.affiliation: Réseau médical, lactarium régional d'Île-de-France, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Serreau
mesh_terms: D001205:Ascorbic Acid / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005527:Food, Fortified; D019983:Guideline Adherence; D006801:Humans; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008895:Milk, Human; D009994:Osmolar Concentration; D014801:Vitamin A / Q000008:administration & dosage; D014807:Vitamin D / Q000008:administration & dosage; D014810:Vitamin E / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D004044:Dietary Proteins; D014815:Vitamins; D014801:Vitamin A; D014807:Vitamin D; D014810:Vitamin E; D001205:Ascorbic Acid