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Homologous fortification of human milk for the preterm very low birth weight infant in developing countries Valentini, Fabio Sergio
Abstract
Human milk is considered as the gold standard for infant nutrition. However, preterm, term, and banked human milk is not nutritionally adequate for the high nutrient requirements of the small premature infant. To meet the nutritional needs of the preterm infant, the nutrient content of human milk needs to be increased. Several studies have been conducted using human milk components as supplements (homologous fortification), and these studies have shown that the rate of weight gain of the premature infants fed fortified human milk approximated intrauterine growth rate. However, the expense associated with this technology limits its practical use, especially in developing countries where finances allocated to the care of the preterm infants are limited and often do not allow for the purchase of such fortifiers. One of the objectives of this study was to assess the feasibility of a simple and inexpensive technique of human milk concentration described by Martinez (1989). Another objective was the preparation of a homologous human milk fortifier using the concentrated human milk. The final objective was to assess the potential nutritional adequacy of the prepared fortified human milk by comparing its nutrient content with the nutrient requirements of the preterm very low birth weight infant. Sixteen donor milk (dHM) samples were concentrated (evaporation and subsequent lactose removal) under vacuum using a rotary evaporator. The concentrated human milk (cHM) obtained had a significantly higher nutrient content (p<0.001) compared to that of dHM. Protein, fat, and lactose content of cHM increased 2.94±0.67, 2.35±0.79, and 2.36±0.33 times, respectively compared to dHM. Calcium, phosphorus, and sodium content of c HM increased 3.69±0.69, 3.67±0.84, and 2.09±0.47 times, respectively compared to dHM. The c HM obtained was then used to fortify dHM resulting in the production of a fortified human milk (fHM). Three different types of fHM ("low", "medium", and "high") were prepared by mixing dHM and c HM at different proportions. The protein content of the fHM preparations was significantly higher than that of dHM (p<0.05). Fat content of the fHM preparations was not significantly different from dHM, with the exception of "high" fHM (p<0.05). Calcium and phosphorus content of the fHM preparations was significantly higher than that of dHM (p<0.001). Only the "medium" and the "high" fHM had a significantly higher sodium content (p<0.001). The osmolality of the fHM increased markedly and was significantly higher in the fHM preparations compared to dHM (p<0.001). The energy content of the fHM preparations was not significantly different from dHM, except for the "high" fHM (p<0.05). Overall, the nutrient content of the fHM preparations was higher than that of dHM. In conclusion, the concentration and homologous fortification of human milk using a simple and inexpensive technique was achieved. However, the increment of the nutrients determined in the cHM showed a high degree of variability. In spite of the increased concentration of nutrients in the fHM, protein, calcium and phosphorus levels may still not meet the requirement of the preterm very low birth weight infant
Item Metadata
Title |
Homologous fortification of human milk for the preterm very low birth weight infant in developing countries
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Creator | |
Publisher |
University of British Columbia
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Date Issued |
1994
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Description |
Human milk is considered as the gold standard for infant nutrition. However, preterm, term, and
banked human milk is not nutritionally adequate for the high nutrient requirements of the small
premature infant. To meet the nutritional needs of the preterm infant, the nutrient content of human
milk needs to be increased. Several studies have been conducted using human milk components as
supplements (homologous fortification), and these studies have shown that the rate of weight gain
of the premature infants fed fortified human milk approximated intrauterine growth rate. However,
the expense associated with this technology limits its practical use, especially in developing
countries where finances allocated to the care of the preterm infants are limited and often do not
allow for the purchase of such fortifiers.
One of the objectives of this study was to assess the feasibility of a simple and inexpensive
technique of human milk concentration described by Martinez (1989). Another objective was the
preparation of a homologous human milk fortifier using the concentrated human milk. The final
objective was to assess the potential nutritional adequacy of the prepared fortified human milk by
comparing its nutrient content with the nutrient requirements of the preterm very low birth weight
infant.
Sixteen donor milk (dHM) samples were concentrated (evaporation and subsequent lactose
removal) under vacuum using a rotary evaporator. The concentrated human milk (cHM) obtained
had a significantly higher nutrient content (p<0.001) compared to that of dHM. Protein, fat, and
lactose content of cHM increased 2.94±0.67, 2.35±0.79, and 2.36±0.33 times, respectively
compared to dHM. Calcium, phosphorus, and sodium content of c HM increased 3.69±0.69,
3.67±0.84, and 2.09±0.47 times, respectively compared to dHM. The c HM obtained was then used to fortify dHM resulting in the production of a fortified human
milk (fHM). Three different types of fHM ("low", "medium", and "high") were prepared by
mixing dHM and c HM at different proportions. The protein content of the fHM preparations was
significantly higher than that of dHM (p<0.05). Fat content of the fHM preparations was not
significantly different from dHM, with the exception of "high" fHM (p<0.05). Calcium and
phosphorus content of the fHM preparations was significantly higher than that of dHM (p<0.001).
Only the "medium" and the "high" fHM had a significantly higher sodium content (p<0.001). The
osmolality of the fHM increased markedly and was significantly higher in the fHM preparations
compared to dHM (p<0.001). The energy content of the fHM preparations was not significantly
different from dHM, except for the "high" fHM (p<0.05). Overall, the nutrient content of the fHM
preparations was higher than that of dHM.
In conclusion, the concentration and homologous fortification of human milk using a simple and
inexpensive technique was achieved. However, the increment of the nutrients determined in the
cHM showed a high degree of variability. In spite of the increased concentration of nutrients in the
fHM, protein, calcium and phosphorus levels may still not meet the requirement of the preterm
very low birth weight infant
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Extent |
10403537 bytes
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Genre | |
Type | |
File Format |
application/pdf
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Language |
eng
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Date Available |
2009-01-24
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Provider |
Vancouver : University of British Columbia Library
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Rights |
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.
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DOI |
10.14288/1.0087004
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URI | |
Degree | |
Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
1995-11
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Campus | |
Scholarly Level |
Graduate
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Aggregated Source Repository |
DSpace
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Rights
For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use.