Story by: Kim Huston on June 16, 2021
Breast milk can be like a medicine for babies. While breast milk is preferred for most babies, it may not naturally contain all of the macronutrients (fat, carbohydrates and protein) needed by premature babies, those born before 37 weeks of pregnancy. Human milk analysis and targeted fortification, a type of “lactoengineering,” is a technology that makes it possible for babies in the neonatal intensive care unit (NICU) and other critically ill babies to get the benefits of breast milk and all the macronutrients they need to heal and grow. Lactoengineering describes all the ways to individualize human milk feedings and fortification. Human milk analysis and targeted fortification is one of these ways. Human milk can be enhanced through lactoengineering in other ways, such as skimming it and separating out “hindmilk,” the high-fat, high-calorie breast milk that babies get toward the end of a feeding.
Breast milk can help babies build immunity, grow and develop. Breast milk contains antibodies from the parent, which pass on some immunity protection from infections the parent experienced in the past. Breast milk also contains proteins, fats, sugars and even white blood cells that work to fight against gastrointestinal (GI) infections. Breast milk also has probiotic factors, helping the body develop a healthy human microbiome, a collection of micro-organisms living in our intestines. A healthy microbiome can help prevent infection and lower risk for conditions such as allergies, asthma and obesity. According to the American Academy of Pediatrics (AAP), children who receive breast milk are less likely to experience ear infections, vomiting, diarrhea, pneumonia, urinary tract infections and certain types of meningitis. Research also shows that children who nurse for more than six months are less likely to develop childhood leukemia and lymphoma than those who receive formula. This may be due to the fact that leukemia and lymphoma are affected by disruptions to the immune system.
Babies in the NICU as well as babies with certain medical conditions may face challenges with breastfeeding or breast milk. Premature babies need additional macronutrients for a variety of reasons. Babies born early can miss out on a surge of nutrient absorption that happens during the third trimester. Premature babies also can have an immature GI tract, which can be less efficient at processing nutrients. Premature babies often can experience complications, including infections, respiratory issues and general stress, which all can increase metabolism.
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While beneficial and nutritious enough for full-term babies, breast milk can be highly variable in terms of its macronutrients. Human milk analysis, a type of lactoengineering, uses a device called a human milk analyzer to provide a nutritional analysis of parent or donor milk. Once analyzed, the milk can be fortified with additional protein, fat and carbohydrates to meet the targeted nutritional requirements for the premature baby. Norton Children’s Hospital has a nutrition prep center with a human milk analyzer available for parent or donor milk that is being prepared and fortified for a NICU patient. For all premature infants born at very low birthweight (less than 1.5 kilograms) whose parent is unable to provide breast milk for any reason, Norton Children’s offers pasteurized donor milk that is obtained from a certified milk bank.
Norton Women’s & Children’s Hospital also has a nutrition prep area to help families of premature babies.
“Fortifying breast milk makes sure that a preterm baby is getting the immunity benefits of breast milk with the required nutrients to support bone mineralization and rapid growth,” said Hannah R. Fischer, M.D., neonatologist with Norton Children’s Neonatology, affiliated with the UofL School of Medicine. “We support parents in the process as they try to provide breast milk, sometimes under difficult circumstances. They’re under stress due to a child being in the NICU, and their body may not have been ready for breastfeeding. We want preterm babies to get as much breast milk as possible before leaving the NICU, from their parent or donor milk, so supporting the process is crucial.”
A child may need to continue with fortified breast milk even after going home. This could include adding a small amount of over-the-counter formula to your pumped milk as discussed with your neonatologist and pediatrician or using a specialized prescription formula.
“Fortifying breast milk does not mean there’s anything wrong with the breast milk,” Dr. Fischer said. “Milk from a parent or donor is the ideal source of nutrients for a baby because their body metabolizes it best. It just may need a boost of nutrients and calories to support their child’s unique needs.”