Optimizing premature nutrition: An updated review of human and donor milk fortification and its implication in growth and neurodevelopmental outcomes

Abstract

Poor intra- and extrauterine growth, as well as inadequate protein supplementation during the first weeks in premature babies, are linked to long-term growth failure and impaired brain development. The calorie requirements of premature newborns cannot every time be fulfilled, even with routine and traditional fortification. This is because conventional fortification relies on the presumed well-known composition of human milk rather than the measured and calculated composition thereof. The protein content of milk in mother’s of preterm babies, varies with breastfeeding duration and the content of donor human milk varies when it is pasteurised and preserved in human milk banks for prolonged duration. Newer fortification techniques, such as individualized, targeted approaches, are required to address these challenges of protein and micronutrient undernutrition, which have led to the concept of “lacto-engineering.” This review article focuses on recent feeding practice updates, including traditional and targeted fortification, bedside human milk content analysis, lacto-engineering, and their implications in neonatal intensive care units, particularly in developing countries.