Breast milk is the best food for premature infants due to its ability to protect infants
from necrotizing enterocolitis (NEC) and late onset sepsis. When a premature infant's
mother's own milk supply is not enough to provide all the milk that her premature infant
needs, donated breast milk is the next best option. One of the downsides of donor breast
milk is that it often does not contain as much nutrition for the developing infant
compared to the milk of a mother of a premature infant. This means a higher likelihood
for poor growth in infant receiving mostly donor breast milk compared to mom's own milk.
Due to an inability to easily measure the nutritional content of donor breast milk,
standard practice has been to assume that the milk has a certain amount of fat,
carbohydrates, and protein. Based on these assumptions, a set amount of additional
nutritional fortifier is added to both donor and mom's own breast milk prior to it being
given to the infant. Studies show that there is often less nutrition in the donor breast
milk to start with than assumed. Technology is now available which uses a small volume
sample to measure fat, protein, and carbohydrates in human milk, and hence, calculate the
calories in the milk. Using this technology, in this study, the investigators will
customize the fortification of donor breast milk by first measuring what is in the milk
and then adding any additional fortification that is needed to reach the recommended
goals for fat, protein, and carbohydrates. The investigators hypothesize that infants
receiving this customized milk, so-called "target" fortified donor breast milk, will have
better growth than infants receiving the standard amount of fortification added to their
donor breast milk.
The study design involves measurement of macronutrient and calorie content of donor
breast milk using a point-of-care human milk analyzer (Miris, AB). The individual
macronutrient (protein, fat, and carbohydrate) concentrations will be targeted in the
intervention group such that the infant will receive protein of 4 g/kg/day, fat of 6.6
g/kg/day, and carbohydrates of 11.6-13.2 g/kg/day. Fortification will be added in a
step-wise fashion daily over a 3-4 day period starting when the infant reaches about 80
ml/kg/day in feeding volume. Fortifiers that may be used in this study include: Abbott
Similac Human Milk Fortifier Extensively Hydrolyzed Protein Concentrated Liquid, Abbott
Liquid Protein, Nestle Microlipid, and Medica Nutrition SolCarb. Participants in the
control arm will receive donor milk that is fortified in the standard fashion at this
institution; that is, 4 packets of Human Milk Fortifier will be added to 100 ml of donor
breast milk. Additional fortification such as liquid protein or microlipid may be added
to the donor milk and mom's own milk in response to poor growth for participants in both
groups, as is standard of care in this Neonatal Intensive Care Unit (NICU). Patients in
both experimental and control groups will always receive mom's own milk first when it is
available. Mom's own milk will not be analyzed and will always be fortified in the
standard fashion for both groups. The participants will be studied until they reach 34
weeks corrected gestational age.