Pediatric Nutrition in Practice

Preterm and Low-Birth-Weight Infants 217

3

cient amounts with the exception of protein, which
is inadequate in most fortifiers. Protein intakes are
therefore often inadequate. The reason why pow-
der fortifiers, and some liquid fortifiers, are too
low in protein is that they were designed at a time
when the overriding consideration was the avoid-
ance of ‘high’ protein intakes in the face of variable
protein concentrations of expressed human milk.
The inevitable consequence is that protein intakes
are too low most of the time. Today the ill effects
of inadequate protein intakes are better known.
Fortifiers (liquid) with higher protein content are
available and should be used. With their use, pro-
tein intakes are adequate most of the time, albeit
being somewhat high at times when the protein
content of expressed milk is relatively high.
Customizing approaches to fortification have
been developed with the aim of overcoming the

inadequacy of protein intakes with powder forti-

fiers. A method for BUN-guided fortification has

been described by Arslanoglu et al. [7]. The meth-

od is somewhat cumbersome, which may be the

reason for its limited use. Approaches based on

periodic analysis of expressed milk (targeted for-

tification) also have been shown to lead to more

adequate nutrient intakes and improved growth

[8].

After Discharge

When preterm infants leave the hospital their nu-

trient needs are still high. In addition, they often

have accrued deficits in bone mineral content.

This is the reason why there is a need for contin-

ued fortification of human milk. In the case of

formula feeding, the use of enriched post-dis-

charge formulas is necessary.

7 Arslanoglu S, Moro GE, Ziegler EE: Ad-

justable fortification of human milk fed

to preterm infants: does it make a differ-

ence? J Perinatol 2006; 26; 1–8.

8 Polberger S, Räihä NCR, Juvonen P,

Moro GE, Minoli I, Warm A: Individual-

ized protein fortification of human milk

for preterm infants: comparison of ul-

trafiltrated human milk protein and a

bovine whey fortifier. J Pediat Gast Nut

1999; 29: 332–338.

References

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1253–1261.
2 Ziegler EE: Meeting the nutritional
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Ann Nutr Metab 2011; 58(suppl 1):8–18.
3 te Braake FWJ, van den Akker CHP,
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4 Boyd CA, Quigley MA, Brocklehurst P:

Donor breast milk versus infant formula

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5 Tyson JA, Kennedy KA: Trophic feed-

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6 Ronnestad A, Abrahamsen TG, Medbø

S, Reigstad H, Lossius K, Kaaresen PI, et

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Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 214–217
DOI: 10.1159/000360342