Human Milk Fortifiers for Preterm Infants

Many premature infants need extra nutrients added to their mother’s milk to achieve the best growth and development. Premature babies often need extra protein, calcium, phosphorus, and even salt, to build strong bones and healthy organs.

These extra nutrients are added to the milk before it is fed to your baby through the gavage (feeding) tube. Sometimes one or more factors are added individually to your milk, but most of the time, these extra nutrients are provided by using a commercially prepared liquid or powdered fortifier. Other babies, such as those with high oxygen needs or intestinal problems may just need extra calories to grow. If only extra calories are needed, sometimes using more hindmilk (which is breastmilk obtained at the end of the feeding or pumping, which has a higher fat content) can improve growth.

Since all the commonly used commercially prepared fortifiers are made from cow’s milk proteins (like regular formulas), some babies may have difficulty initially when the fortifier is added. They may have delayed emptying from the stomach, abdominal distention or even gas. The stools may change somewhat in color. If that happens, the doctor may remove the fortifier and try again at a later time. New fortifiers made from human milk proteins are under investigation and may be available in the next few years.

It is important to remember that your baby needs these extra nutrients because of his prematurity or illness – not because there is a problem with your milk. As most premature infants are discharged home a few weeks before they were due to be born, some infants may require fortification for a time after being discharged home.