What is Breast Milk Fortification?
Breast milk fortification involves adding a supplement, known as a fortifier, to expressed breast milk (EBM). While human milk is the ideal nutrition for infants, its nutritional composition may not be sufficient to meet the accelerated growth demands of premature babies or those with certain medical conditions. Fortifiers contain additional protein, calories, vitamins, and minerals, like calcium and phosphorus, to promote healthy bone and tissue development. This allows the infant to receive a high-nutrient diet without needing to consume larger, potentially overwhelming volumes of milk.
Who Needs Fortified Breast Milk?
Fortification is a medical intervention and is not for all newborns. It is exclusively recommended and prescribed by a doctor or neonatal dietitian. The primary candidates for fortified breast milk are:
- Premature infants: Especially those born before 32 weeks gestation or with a very low birth weight (under 1800g).
- Infants with extrauterine growth restriction (EUGR): Babies who are not gaining weight at an optimal rate, even with an adequate breast milk intake.
- Infants with specific medical conditions: Conditions such as congenital heart problems or chronic lung disease that increase nutritional demands.
Types of Breast Milk Fortifiers
There are several types of fortifiers available, primarily categorized by their source and application method:
- Bovine Milk-Based Fortifiers: Most commercial fortifiers are made from processed cow's milk protein. The proteins are broken down (hydrolyzed) to be more easily digested and to minimize the risk of cow's milk protein allergy.
- Human Milk-Based Fortifiers: These fortifiers are derived from pasteurized human milk and offer a composition that is even more biologically matched to the infant's needs.
- Single-Component Fortifiers: These are sometimes used for individualized fortification strategies. They provide specific nutrients like protein, fat, or carbohydrates separately, allowing for more precise adjustments based on an infant’s blood work and growth response.
The Process of Fortifying Breast Milk at Home
Parents who are taught how to fortify breast milk for newborns at home are given clear, written instructions by their neonatal care team. The process involves careful handling and mixing of expressed breast milk (EBM) and the prescribed fortifier.
- Prepare the workspace: Ensure a clean, dry surface and thoroughly wash your hands with soap and water.
- Gather equipment: Collect the prescribed fortifier sachets, a sterile bottle or syringe, and freshly expressed or properly thawed EBM.
- Warm the milk: Warm the measured EBM to body temperature by placing the container in warm water. Avoid using a microwave.
- Mix the fortifier: Add the prescribed amount of fortifier powder to the milk. Roll or gently swirl the bottle to dissolve the powder completely. Vigorously shaking is not recommended, as it can disrupt the milk's properties.
- Feed immediately: Use the fortified milk as soon as it's prepared. Fortified breast milk cannot be stored for prolonged periods and should not be re-heated.
- Administer the feed: Depending on the infant's feeding method, the fortified milk can be given via bottle, cup, or syringe. If breastfeeding, a small volume of the concentrate may be given via a syringe before the breastfeed.
Standard vs. Individualized Fortification
The practice of fortification has evolved over the years, with modern approaches moving towards more personalized care. Both methods have distinct characteristics.
| Feature | Standard Fortification | Individualized Fortification (Adjusted or Targeted) |
|---|---|---|
| Method | A fixed amount of multi-component fortifier is added to a specific volume of breast milk, typically aiming for a target calorie density (e.g., 24 kcal/oz). | Based on lab analysis of the infant's own breast milk or metabolic response (e.g., blood urea nitrogen) to guide the precise amount of fortifier needed. |
| Variability | Assumes a consistent nutrient profile in breast milk, which is often not the case. | Accounts for the natural variability in the nutritional content of human milk, allowing for more precise nutritional delivery. |
| Key Advantage | Simple, widely used, and effective for many infants. | Provides a more accurate and tailored nutritional intake, potentially optimizing growth and minimizing risks. |
| Key Disadvantage | May lead to over or under-nutrition due to natural variation in breast milk composition. | More complex, resource-intensive, and may not be available in all neonatal units. |
Potential Side Effects and Monitoring
While fortification is generally well-tolerated, some infants may experience side effects. Your care team will monitor your baby closely when starting the fortifier. Possible side effects include:
- Changes in stool consistency (thicker stool or constipation).
- Increased vomiting.
- Mild metabolic acidosis.
- In rare cases, feeding intolerance requiring an adjustment in the fortification schedule.
It is crucial that fortification is managed by medical professionals to minimize these risks and ensure the baby receives the correct amount of nutrients.
Conclusion
Breast milk fortification is a safe and effective method for supporting the growth and development of premature and vulnerable newborns. The process, which involves adding a specialized supplement to expressed breast milk, is performed under strict medical guidance. It ensures that infants with high nutritional demands receive the extra calories, protein, and minerals needed to thrive while still benefiting from the unique protective qualities of breast milk. Parents involved in at-home fortification receive thorough training to ensure the supplement is prepared and administered correctly. By working closely with a neonatal care team, parents can help give their baby the best possible start in life. For additional information on newborn care, the National Institutes of Health (NIH) provides a vast library of resources on infant health.
