359 - Comparisons of energy and macronutrient composition of pasteurized donor breast milk and preterm mother’s breast milk for nutrition and growth of preterm infants

Poster Number: 359
Publication Number: 359.101

Laura Varney, Georgetown University Hospital, Arlington, VA, United States; Margarita Suarez, Georgetown University Hospital, Washington, DC, United States; Loredana Cunningham, Georgetown University School of Medicine, Great Falls, VA, United States; Sejal Dave, Georgetown University, Washington, DC, United States; Lewis P. Rubin, Georgetown University Medical Center, Washington, DC, United States

Background: Human milk (HM) is recommended for all infants, including those born preterm, for whom HM-based diets decrease risk/severity of several prematurity-related complications and are associated with improved neurodevelopmental outcomes. Consequently, NICU care of very preterm infants increasingly includes feeding expressed mother's breast milk (MBM) or, when MBM is unavailable, insufficient, or contraindicated, with pasteurized donor breast milk (PDBM). Although information on PDBM content variation and ranges is limited, previous studies of its composition from different locations and using different analytic methods suggest PDBM may show up to 2-fold energy/macronutrient differences.

Objective:

Compare energy and macronutrient composition of PDBM obtained from the Human Milk Banking Association of North America with MBM from lactating mothers of preterm infants in a Level IV NICU and determine (1) the extents to which PDBM meets preterm infant energy and protein requirements and (2) if different fortification strategies are suggested by type of HM-based diet.

Design/Methods:

The Miris Human Milk Analyzer™, an FDA-approved, mid-infrared transmission spectrometer, was used to measure energy, protein, fat, and carbohydrate content in PDBM samples and expressed MBM from mothers of preterm (< 34 weeks gestation) infants. Milk aliquots were analyzed weekly and reported to the NICU care teams as part of each infant’s personalized nutritional planning. Student’s t tests or Mann-Whitney U-tests and ANOVA were used to compare MBM and PDBM composition and MBM changes during lactation, respectively.

Results:

319 preterm MBM (including longitudinal) and 30 PDBM samples were analyzed. Analyses for the same lots of PDBM given to multiple infants (n=6) yielded identical values. PDBM contained 19.1±2.2 (mean±SD) kcal/oz; 0.8±0.3 g/dL protein, 3.0±0.5 g/dL fat, and 7.7±0.5 g/dL carbohydrate. By comparison, preterm MBM samples contained 22.6±4.3 kcal/oz, 1.3 ± 0.5 g/dL protein, 4.0±1.42 g/dL fat, and 7.9±0.6 g/dL carbohydrate. As lactation progressed, preterm MBM energy and protein progressively declined but still remained greater than PDBM content.

Conclusion(s):

Unfortified PDBM does not meet recommended nutritional intakes for preterm infants, especially energy and protein. In this series, low protein content was similar to several previous reports, but energy content was more consistent. Although PDBM is routinely provided to preterm infants, it may not meet nutritional needs or adequately support growth, warranting a modified human milk fortification approach.