Lactational Stage of Pasteurized Human Donor Milk Contributes to Nutrient Limitations for Infants.
BACKGROUND
Mother's own milk is the first choice for feeding preterm infants, but when not available, pasteurized human donor milk (PDM) is often used. Infants fed PDM have difficulties maintaining appropriate growth velocities. To assess the most basic elements of nutrition, we tested the hypotheses that fatty acid and amino acid composition of PDM is highly variable and standard pooling practices attenuate variability; however, total nutrients may be limiting without supplementation due to late lactational stage of the milk.


METHODS
A prospective cross-sectional sampling of milk was obtained from five donor milk banks located in Ohio, Michigan, Colorado, Texas-Ft Worth, and California. Milk samples were collected after Institutional Review Board (#07-0035) approval and informed consent. Fatty acid and amino acid contents were measured in milk from individual donors and donor pools (pooled per Human Milk Banking Association of North America guidelines). Statistical comparisons were performed using Kruskal-Wallis, Spearman's, or Multivariate Regression analyses with center as the fixed factor and lactational stage as co-variate.


RESULTS
Ten of the fourteen fatty acids and seventeen of the nineteen amino acids analyzed differed across Banks in the individual milk samples. Pooling minimized these differences in amino acid and fatty acid contents. Concentrations of lysine and docosahexaenoic acid (DHA) were not different across Banks, but concentrations were low compared to recommended levels.


CONCLUSIONS
Individual donor milk fatty acid and amino acid contents are highly variable. Standardized pooling practice reduces this variability. Lysine and DHA concentrations were consistently low across geographic regions in North America due to lactational stage of the milk, and thus not adequately addressed by pooling. Targeted supplementation is needed to optimize PDM, especially for the preterm or volume restricted infant.
The Division of Obstetrics and Gynecology, The University of Cincinnati, Cincinnati, OH, 45220, USA2OhioHealth Mothers' Milk Bank of Ohio, Columbus, OH, 43215, USA3Akron Children's Hospital, Akron, OH, 44308, USA4Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Padualaan 8, 3584 CD, Utrecht, The Netherlands5Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA6Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA. Christina.valentine@mjn.com.
Christina J
CJ
Valentine
OhioHealth Mothers' Milk Bank of Ohio, Columbus, OH, 43215, USA. georgiamor@gmail.com.
Georgia
G
Morrow
Akron Children's Hospital, Akron, OH, 44308, USA. ahodge@gmail.com.
Amanda
A
Reisinger
Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Padualaan 8, 3584 CD, Utrecht, The Netherlands. kdingess.2310@gmail.com.
Kelly A
KA
Dingess
Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA. Ardythe.Morrow@cchmc.org.
Ardythe L
AL
Morrow
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA. Lynette.Rogers@Nationwidechildrens.org.
Lynette K
LK
Rogers
D000328:Adult; D000596:Amino Acids / Q000032:analysis; D003430:Cross-Sectional Studies; D004281:Docosahexaenoic Acids / Q000032:analysis; D005227:Fatty Acids / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D007774:Lactation; D008239:Lysine / Q000032:analysis; D017784:Milk Banks; D008894:Milk Proteins / Q000032:analysis; D008895:Milk, Human / Q000737:chemistry*; D009656:North America; D009753:Nutritive Value; D061352:Pasteurization; D011446:Prospective Studies; D055815:Young Adult
D000596:Amino Acids; D005227:Fatty Acids; D008894:Milk Proteins; D004281:Docosahexaenoic Acids; D008239:Lysine
DHA; donor milk; human milk; lysine; nutrition; preterm infants